Effect of preoperative immunonutrition on postoperative short‐term outcomes of patients with head and neck squamous cell carcinoma

Aeberhard, Carla; Mayer, Catherine; Meyer, Simone; Mueller, Simon A.; Schuetz, Philipp; Stanga, Zeno; Giger, Roland

doi:10.1002/hed.25072

Cited by 24 publications

(24 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some researchers have suggested that specific formulae, generally referred to as immuno-nutrition including high amounts of arginine, glutamine, branched chain amino acids, n-3 fatty acids, and nucleotides, may provide further benefit for infection patients also including COVID-19 patients. Yet, such treatments were not studied in the EFFORT trial, nor to our knowledge, in any other trial [ [45] , [46] , [47] ]. Still, some data suggest that a diet enriched with eicosapentaenoic acid (EPA) and g-linolenic acid (GLA) may favorably reduce the pulmonary inflammatory response and support vasodilation and oxygenation in septic patients [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. Methods For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. Results We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. Conclusion This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. Clinical trial registration Registered under ClinicalTrials.gov Identifier no. NCT02517476.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…48 Furthermore, in a retrospective study on 411 H&N cancer patients, preoperative immunonutrition was associated with a shorter length of hospital stay and a lower rate for wound infections and local complications, with more pronounced effects in those with previous RT and extensive surgery. 49 During CT-RT, a controlled, randomized, prospective, double-blind, multicenter study on 111 patients with H&N and esophageal cancer showed that functional capacity and nutritional status were maintained in those receiving an immuneenhanced supplement and reduced in controls receiving a standard enteral diet. 50 Furthermore, in a small pilot study conducted on 31 non-metastatic stage III or IV H&N cancer patients treated with concomitant CT-RT, immunonutrition provided orally during 5 days before each cycle of CT was shown to be associated with a favorable modulation of inflammatory and oxidative status, and a low incidence of severe acute mucositis was noted.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

et al. 2021

View full text Add to dashboard Cite

Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.

show abstract

“…Arg is a semi-essential amino acid that has positive effects on immune function and reparative collagen synthesis, and it is thought to be an enhancer of T-cells [34,35]. Omega-3 fatty acids have anti-inflammatory effects that can promote wound healing, and enhance the adaptive immune response [36].…”

Section: Discussionmentioning

confidence: 99%

Effects of Enteral Immunonutrition in Patients Undergoing Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Guan

Chen

Huang³

2018

Ann Nutr Metab

View full text Add to dashboard Cite

Background: The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. Methods: A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. Results: Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37–0.92; p = 0.02) and shortened the length of hospital stay (MD –1.79, 95% CI –3.40 to 0.18; p = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62–1.05; p = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69–1.28; p = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37–16.10; p = 0.36). Conclusions: EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.

show abstract

Effect of preoperative immunonutrition on postoperative short‐term outcomes of patients with head and neck squamous cell carcinoma

Abstract: Patients receiving preoperative immunonutrition had a shorter hospital LOS and a lower rate for wound infections and local complications. These effects remained robust after a multivariate adjustment.

Cited by 24 publications

References 34 publications

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

Effects of Enteral Immunonutrition in Patients Undergoing Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Contact Info

Product

Resources

About