Metabolic changes associated with radical cystectomy.

The present study investigates the metabolic changes associated with cystectomy and the effects of nutritional support on the cystectomy patient. Twelve patients undergoing radical cystectomy and ileal conduit urinary diversion for invasive bladder cancer were randomly assigned to receive either a diet of 5 per cent dextrose (Group I) or total parenteral nutrition (Group II) given as glucose and amino acids. Group I demonstrated a marked negative nitrogen balance throughout the study while Group II had minimal losses for the first three days and achieved positive nitrogen balance by the fourth postoperative day. Over six postoperative days, cumulative nitrogen balance was -1.08 +/- 0.35 and -0.02 +/- 0.16 gm./kg. (p less than .001) in Groups I and II, respectively. Energy expenditure, compared to predicted values, was 15 percent higher (p less than .01) in Group II than in Group I. The respiratory quotient in the total parenteral nutrition group remained below 1.0, an indication of ongoing net fat oxidation despite hypercaloric glucose intake. Patients on total parenteral nutrition tended to show elevations in norepinephrine excretions as well as a transient rise in rectal temperature (p less than .05). The highest body temperature in both groups was recorded on the third postoperative day. The energy cost of radical cystectomy was similar to that in patients undergoing total hip replacement. However, lean tissue losses and norepinephrine concentrations were much higher than for hip patients and were comparable to changes seen in severe accidental injury. The tissue losses were completely abolished by total parenteral nutrition. The observation that nutrition affects temperature regulation in acutely ill patients has implications for interpreting increases in body temperature in injured patients receiving total parental nutrition. Fever may not necessarily indicate the development of infection.

RCT Entities:   Population Interventions Outcomes