Protein-sparing in cystectomy patients

Forty-four patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer were studied prospectively to evaluate the substitution of crystalline amino acids (A₃W) for dextrose (D₅W) in the postoperative fluid management. Nutritional assessment revealed that 17 (39%) of the 44 patients were malnourished preoperatively, while the post operative complication rate in group 1 (D₅W) was 33% versus 17% in group 2 (A₃W). Nitrogen losses in both groups were low, secondary to the large amounts of albumin used postoperatively. However, more exogenous albumin was needed postoperatively to maintain serum albumin levels in group 1 compared to group 2 (77.5 ± 3.1 gm. versus 65 ± 5.2 gm.). Cell-mediated immunity determined by reactivity to a battery of recall antigens revealed that 56% (5) of the patients in group 1 were able to maintain the skin test reactivity throughout the postoperative course, while 94% (17) of the patients in group 2 maintained reactivity during the same period. Four nutritionally depleted patients in group 1 required conversion to a forced feeding regimen (intravenous hyperalimentation), while none of the group 2 patients required a change in the nutritional regimen. The operative approach to invasive bladder cancer represents a major category of injury. Both preoperative x-ray therapy and the surgical extirpation of this disease are associated with considerable nutritional depletion. Early nutritional support in the management of patients with invasive bladder cancer is mandatory and in those instances when hypocaloric feeding regimens are appropriate the use of crystalline amino acids in place of dextrose solutions would appear to be indicated.