[Parenteral hyperalimentation and cystoprostatectomy for carcinoma of the bladder (author's transl)].
The authors report a series of 16 total cystoprostatectomies with only one postoperative death. Eleven of these operations, performed with the intention of achieving a complete cure, were carried out after flash radiotherapy of 1.000 rads on the day before surgery and were completed by uretero-sigmoidostomy. The five palliative operations were completed by direct bilateral cutaneous ureterostomy, the patients having received preoperative radiotherapy of 5 to 6,000 rads. The authors attribute the low postoperative mortality to the value of the energy and protein provided by parenteral hyperalimentation which made it possible to administer to the patient from the day after surgery onwards 1,400 to 2,600 calories per day (60% as carbohydrate and 40% as lipids) and 1 gram/kilo of protein per day. Infusion catheters were inserted under strictly aseptic conditions on the day prior to surgery into the deep main veins by percutaneous puncture of a subclavian vein or cutdown of an external jugular vein, and were kept in place until such time as oral alimentation could ensure an equivalent intake. For the 11 patients undergoing curative surgery, weight loss at the time of discharge was no more than 1 to 2 kilos, a figure to be contrasted with the 7 to 8 kilos before the use of parenteral hyperalimentation. The only death occurred amongst the 5 patients undergoing palliative surgery. In the latter group, the authors were stuck by the uncomplicated postoperative course, and the control of complications such as intestinal obstruction or bacteraemia which was obviously better in veiw of the maintenance of the calorie reserves of the body. All parenteral hyperalimentation was administered in the form of commercial solutions and emulsions.