USEFULNESS OF PERIOPERATIVE NUTRITIONAL THERAPY WITH THE GLUTAMINE/ARGININE/CALCIUM β-HYDROXY-β-METHYLBUTYRATE PRODUCT IN ESOPHAGEAL CANCER SURGERY

Background We clarify the impacts of glutamine-enriched nutrition therapy in the perioperative period of minimally invasive esophagectomy (MIE) for esophageal cancer on short- and long- term postoperative outcomes. We investigated the influence of the use of Gln/Arg/HMB products on the incidence of postoperative complications and the the nutritional status including the. Methods We investigated the association between the use of Gln/Arg/HMB products and postoperative complications and the nutritional status. 193 patients underwent MIE for esophageal cancer (114 patients administered Gln/Arg/HMB products, Gln/Arg/HMB group; 79 patients without Gln/Arg/HMB products, control group). The sum of bilateral psoas muscle areas (PMA) at the level of the third lumbar vertebrae obtained from the CT images taken before and after surgery was defined as sarcopenia according to the sarcopenia standards criteria (cutoff values of 6.36 and 3.92 cm2/m2 for men and women, respectively). Results The Gln/Arg/HMB group showed significantly lower incidences of all complications, sputum expectoration disorder, and pleural effusion of CD-grade ≥ III (38.6% vs. 62.0%, 28.1% vs. 44.3%, 13.2% vs. 27.8%, respectively). The body weight and PMA a month after MIE are preserved significantly higher in the Gln/Arg/HMB group (95.3% vs 93.6%, P<0.001; 99.9% vs 93.5%, P<0.001, respectively). In the multivariate analyses, only fN1 or higher and R1 or more residual tumor were found as the significant predictors of poor prognosis. Conclusion Perioperative management, including nutritional therapy using Gln/Arg/HMB products, may prevent the onset of complications and minimize their impact, leading to improved short-term postoperative outcomes and the maintenance of skeletal muscle mass.