Protein-Sparing in Cystectomy Patients

Abstract

Forty-four patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer were studied prospectively in order to evaluate the substitution of crystalline amino acids (A₃ W) for dextrose (D₅ W) in their postoperative fluid management. Nutritional assessment revealed 17 (39%) patients to be malnourished prior to operation; the postoperative complication rate in Group I (D₅ W) was 33% vs 17% in Group II (A₃ W). Nitrogen losses in both groups were low, secondary to the large amounts of albumin used postoperatively; however, more exogenous albumin was needed after operation to maintain serum albumin levels in Group I compared with Group II (77.5 $$ 3.1 gm vs 65 $$ 5.2 gm). Cell-mediated immunity, determined by reactivity to a battery of recall antigens, revealed that 56% (5) of Group I patients were able to maintain their skin test reactivity throughout the postoperative course compared with 94% (17) in Group II. Four nutritionally depleted patients in Group I required conversion to a forced feeding regimen (IVH), while none of those in Group II required a change in nutritional regimen. Invasive bladder cancer represents a major injury; and preoperative x-ray therapy along with surgical extirpation is associated with considerable nutritional depletion. Early nutritional support in the management of these patients is mandatory, and where hypocaloric feeding regimens are appropriate, the use of A₃ W in place of D₅ W solutions would appear to be indicated.