Parenteral hyperalimentation in surgical patients with head and neck cancer: A randomized study

Abstract

Sixty-nine patients were entered in a randomized study to determine the usefulness and practicality of parenteral hyperalimentation (TPN) in preparing and supporting patients with head and neck cancer undergoing radical resections. The patients were stratified by nutritional status and prognosis and randomization were done within each strata to TPN or control. Minimum full TPN was given at 35 calories/kgm/day for at least 14 days postoperatively. Eight patients received preoperative TPN also. Control patients received customary enteral alimentation by feeding tubes. Under the conditions of this particular study, the administration schedules, and type of solutions used, we were unable to demonstrate any superiority of TPN over conventional enteral nutrition in terms of immune parameters, wound healing, complications, and survival.

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

“…The majority of PN vs SOD 41-51 studies find no differences in morbidity 41 or mortality, 41,48 or even increased morbidity 46,47,50 or mortality, 42 with the use of PN. Those studies that did indicate benefits from PN tended to include heterogeneous populations 43,45 that consisted of both malnourished and well nourished patients.…”

“…Perioperative nutrition support therapy may be beneficial in moderately or severely malnourished patients if administered for 7-14 days preoperatively, but the potential benefits of nutrition support must be weighed against the potential risks of the nutrition support therapy itself and of delaying the operation. (Grade: A) Rationale: Studies specifically assessing the use of perioperative NST in moderately or severely malnourished cancer patients, as assessed by the SGA, the PGSGA, or the NRI, 41,42,45,46,49,51,52,57 indicate a benefit in morbidity 8,45,46,51,52,57 and mortality. 8,51,57 These studies began administration of NST 7-14 days preoperatively.…”

The impact of nutritional status on the prognoses of patients with advanced head and neck cancer

“…Although malnutrition is reported to occur frequently in head and neck cancer patients, [11][12][13] little attention has been paid to its prognostic effect on postoperative morbidity and survival in this specific patient category. In a previous study, we prospectively investigated the possible correlation between malnutrition and the occurrence of postoperative complications in a group of 64 patients with head and neck cancer.…”

Nutritional concepts and considerations in head and neck surgery

“…47 In this study, no significant differences were noted in postoperative wound complications, immune parameters, or survival when TPN was compared with enteral feeding. Although postoperative weight gain was significantly different, the authors feel this may have represented fluid retention in the TPN group.…”