Optimal Nutritional Support in Surgery for Bladder Cancer: Preservation of Visceral Protein by Amino Acid Infusions

Abstract

Seventeen patients undergoing 19 major urological operations for bladder cancer or rectal leiomyosarcoma (1 case) were studied after randomization for 3 hypocaloric dietary regimens, preoperative keto-adaptation by a carbohydrate-free, oral protein diet continued in the postoperative period by isotonic amino acid infusions, postoperative amino acid infusions only and 5% dextrose infusions. In these normally nourished patients serum transferrin (plus 13 mg/dl, minus 30 mg/dl, minus 69 mg/dl., P < 0.05 for the 1st and combined amino acid groups against the 3rd group) and 2 other short half-life hepatic secretory proteins, prealbumin and retinol-binding protein, represented sensitive indexes of visceral protein and nutritional support, superior to N balance, anthropometric assays, delayed hypersensitivity skin test reactivity and serum albumin. Near isotonic amino acid infusions were more effective in preserving visceral protein status than 5% dextrose but preoperative keto-adaptation had no increased benefit over protein-sparing therapy given only after an operation.