W27 MONITORING RESPONSE TO PARENTERAL NUTRITION (TPN) J.A.R. Smith, J.M. Simms, H.F. Woods. Departments of Surgery and Therapeutics, Royal Hallamshire Hospital, Sheffield, Enqland

TPN after total cystectomy or oesophagogastrectomy confers no clinical or metabolic benefit (1) (2). Nutritional indices can be used to predict prognosis, and we have assessed the same indices as a monitor of efficacy. The Prognostic Index (PI) has been derived from the original PNI - PI - 152.2 - 1.66 (Alb) - 0.78 (TSF) - 0.53 (TIBC). PI over 60 carries a 73% rate of complications. 106 patients having colectomy, total cystectomy or oesophagogastrectomy were studied. They were randomly allocated to three groups according to their post operative fluid infusion. (1) Control - 5% Dextrose : N Saline (2) TPN - full parenteral nutrition (3) IAA - 14.1 G N/day isotonic amino acids. Prognostic index was measured before surgery and 5 days post operatively. For each condition there were no differences between the groups in clinical outcome or protein status. Despite improved nitrogen balance achieved by TPN or IAA, in all three types of surgery, the PI deteriorated to a similar extent in all three infusion groups. This implies either (1) that nutritional support is truly ineffective or (2) that the changes in the indices which constitute the PI are more adversely affected by surgery or dilution than positively influenced by nutritional support. We can identify poor prognosis using nutritional indices but cannot use the same indices to monitor the efficacy of nutritional support. (1) A comparison of peripheral and central venous nutrition after major abdominal surgery. Smith, J.A.R., Woods, H.F. and Simms, J.M. ESPEN, Netherlands, September 1981 (2) Intravenous feeding after total cystectomy - a controlled trial. Simms, J.M. and Smith, J.A.R. ESPEN, Netherlands, September 1981

w28 COMPARISON BETWEEN PRE-OPERATIVE ENTERAL (NASO-GASTRIC TUBE) AND PARENTERAL FEEDING IN PATIENTS WITH CANCER OF THE OESOPHAGUS UNDERGOING SURGERY M. Moghissi, P. Teasdale, M. Dench. Humberside Cardiothoracic Surqical Centre, Cottlngham, N. Humberside, England

76 patients with cancer of the oesophaqus were randomised to naso- gastric tube jeeding (N.G.T.F.), Group A, or parentera feeding (I.V.F.), Group B. All were clinicallv and nutritionallv assessed on admission (Period I) and classed as'severe, moderate or"mild nutritional status. They were then given supplementary nutrition in their respective group to the identical calories and nitrogen amount for Kg/b.w., 6-8 days. The clinical and nutritional assessments were repeated (Period III. after which thev had surgery. The operable patients in both groups were treated similarly by I.V.F. for 6-7 days, then orallv thill their discharae. Clinical and nutri- tional studies were made at the-immediate (Period Iii) and the late (Period IV) post-operative phase. The data and the results were analysed on the basis of a) mutritional comparison between the two groups at the different periods: this showed no significant difference between the two groups, except for those in severe deficiency on admission. They dispayed a greater improvement (pre-operatively only) in Group B. b) clinical study and out- come of surgery: in 6 patients of Group A, N.G.T.F.could not be satisfac- torily introduced, maintained or tolerated. These and the 18 patients in both groups who were inoperable (25%) were eliminated from the study. In the remaininq 52, there were 27 in Grout A and 25 in Grouo B: 5 oatients in Group A died, 4 from infective complications (mortality 18.5%), compared with 1 in Group B from infective complications (4%). There were 4 other patients with pleuro-pulmonary complications in‘Grbup A (14.8%) compared with 1 in Group B (4%). The significance of these results is discussed. The conclusions drawn from this experience suggest that for patients with cancer of the oesophagus, pre-operative I.V.F. is more appropriate.

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