Postsurgery enteral nutrition in head and neck cancer patients

Abstract

Objective: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an arginineenriched diet, could improve nutritional variables as well as clinical outcomes. Design: Randomized clinical trial. Setting: Tertiary care. Subjects: A population of 47 patients with oral and laryngeal cancer were enrolled. Interventions: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplemented with arginine and fiber (group I); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II). Results: No significant intergroup differences in the trend of the three plasma proteins and lymphocytes were detected. Gastrointestinal tolerance (diarrhea) of both formulas was good (17.4% group I and 8.3% group II; NS). During the 3 months after hospital discharge five patients died; no diferences were detected between groups (13% group I and 8.3% group II; NS). The incidences postoperative infection complications were similar (nine patients) in both groups (21.7% group I and 16.7% group II; NS). Fistula were less frequent in enriched nutrition group (0% group I and 20.8% group II; P < 0.05); wound infection was more frequent in group II, but without statistical difference (4.3% group I and 12.5% group II; NS). The length of postoperative stay was 22.8 AE 11.8 days in the enriched group and 31.2 AE 19.1 days in the control group (P ¼ 0.07). Conclusions: In conclusion, enriched formula improves local wound complications in postoperative head and neck cancer patients. Our results suggest that these patients could benefit from an immunonutrient-enhanced enteral formula.

Immunoenhanced enteral nutrition, effect on inflammatory markers in head and neck cancer patients

“…Other studies have shown that arginine increased lymphocytic interleukin-2 production by macrophages . There is evidence suggesting that enteral nutrition, supplemented with different agents including arginine and dietary fiber, improve immune function and reduce postoperative complications, in head and neck cancer patients (Van Bokhorstde van der Schueren et al, 2001) (De Luis et al, 2002). Our group (De Luis et al, 2003) did not find influence on interleukins blood levels with an arginine-enhanced enteral formula in a randomized clinical trial with two intervention groups.…”

“…There is evidence suggesting that enteral nutrition, supplemented with immunomodulatory agents including arginine, improve immune function and reduced postoperative complications, in head and neck cancer patients (Riso et al, 2000;Van Bokhorst-de van der Schueren et al, 2001;De Luis et al, 2002).…”

Randomized clinical trial with an enteral arginine-enhanced formula in early postsurgical head and neck cancer patients

“…There is evidence suggesting that enteral nutrition, supplemented with different agents, including arginine and dietary fiber, improve immune function and reduce postoperative complications in different groups of patients such as pancreatic surgery , surgery of stomach and colo-rectal cancer (Gianoti et al, 1999;Wu et al, 2001), and critically ill patients (Caparros et al, 2001). In a previously randomized clinical trial, our group has demonstrated a decrease in local complications of postsurgical patients with head and neck cancer (de Luis et al, 2002). In this study, differences in formulas were arginine and dietary fiber, and perhaps fiber had a role in the detected differences.…”

A study on management of oral cancer in a tertiary care hospital

“…This was similar to findings in study, which revealed most pain in cancer can be controlled by pharmacological treatment with orally administered analgesics, either alone or supplemented with co-analgesic (adjuvant) drugs. 26,27 Other short term effects caused by chemoradiotherapy and surgery were treated appropriately using drugs. And most of the patients presented with more than one side effect at a given point of time, and treatment of which led to polypharmacy which accounted upto a total of 580 prescriptions of adjuvant drugs.…”

“…This was similar in contrast to study by, insufficient calorie intake leading to malnutrition and loss of weight in patients with oral cancer. [23][24][25][26] The NSAIDS/ opioids was prescribed to many patients, who complained of different types of pain (79%) like tongue pain, mouth pain, pain when swallowing, pain in the palate, burning mouth, gingival pain and pain when chewing. Therefore to relieve pain, systemic drugs (12.76%) like tramadol, paracetamol, aspirin and severe pain morphine was prescribed in our study.…”