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 a higher dose of arginine-enhanced diet (17 g/day) than previous studies, could improve nutritional variables as well as clinical outcomes, when compared with a control enteral diet.
Design:
Randomized clinical trial.
Setting:
Tertiary care.
Subjects:
A population of 72 patients with oral and laryngeal cancer was enrolled.
Interventions:
At surgery, patients were randomly allocated to two groups: (a) 35 patients receiving an arginine-enhanced formula with arginine (group I) and (b) 37 patients receiving an isocaloric, isonitrogenous enteral formula (group II).
Results:
No significant intergroup differences in the trend of the three plasma proteins (albumin, transferrin, prealbumin) and lymphocytes were detected. Episodes of diarrhea rate were equal in both groups (22.8% group I and 21.6% group II: NS). The postoperative infections complications were equal in both groups (5.7% group I and 5.4% group II: NS). Fistula (wound complication) was less frequent in enriched nutrition group (2.8% group I and 18.9% group II: P<0.05), whereas wound infection was similar in both groups. The length of postoperative stay was similar in both (27.9±21 vs 28.2±12 days; NS).
Conclusions:
At this dose, arginine-enhanced formula improves fistula rates in postoperative head and neck cancer patients without a high rate of diarrhea.
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References
Arriaga MA, Johnson JT, Kanel KT, Myers EN (1990). Medical complications in total laryngectomy: incidence and risk factors. Ann Otol Rhinol Laryngol 99, 611–615.
Bassett MR, Dobie RA (1990). Patterns of nutritional deficiency in head and neck cancer. Otol Head Neck Surg 91, 119–125.
Caparros T, Lopez J, Grau T (2001). Early enteral nutrition in critically ill patients with a high protein diet enriched with arginine, fiber and antioxidants compared with a standard high protein diet. The effect on nosocomial infections and outcome. J Parenter Enter Nut 25, 299–309.
Cummings JH (1983). Fermentation in the human large intestine: evidence and implications for health. Lancet 138, 1206–1209.
Daly JM, Reynolds J, Thom A (1998). Immune and metabolic effects of arginine in the surgical patient. Ann Surg 208, 521–523.
de Luis DA, Aller R, Cabezas G, Terroba C, Cuellar L (2000). Estado nutricional en pacientes con tumores de cuello. Nutr Clin Diet 2, 21–26.
De Luis DA, Aller R, Izaola O, Cuellar L, Terroba MC (2002). Postsurgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr 56, 1126–1129.
De Luis DA, Izaola O, Aller R, Cuellar L, Terroba MA (2004). Randomized clinical trial with an enteral arginine-enhanced formula in early postsurgical. Eur J Clin Nutr 58, 1505–1508.
Di Carlo V, Gianotti L, Balzano G, Zerbi A, Braga M (1999). Complications of pancreatic surgery and the role of perioperative nutrition. Dig Surg 16, 320–326.
Farreras N, Artigas V, Cardona D, Rius X, Trias M, Gonzalez JA (2005). Effect of early postoperative enteral inumnonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr 24, 55–65.
Gianoti L, Braga M, Fortis C, Soldini L, Vignali A, Clombo S et al. (1999). A prospective, randomized clinical trial on perioperative feeding with an arginine, omega-3 fatty acid, and RNA-enriched enteral diet. Effect on host response and nutritional status. J Parenter Enter Nutr 23, 314–320.
Goncalves Dias MC, de Fatima Nunes M, Nadalin W, Waitzberg DL (2005). Nutritional intervention improves the cloric and proteic ingestion of head and neck cancer patients under radiotherpy. Nutr Hosp 20, 320–325.
Martin Villares C, Fernandez ME, San Roman Carbajo J, Tapia Risueno M, Dominguez Calvo J (2003). Postoperative nutrition in patients with head and neck cancer. Nutr Hosp 18, 243–247.
Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A et al. (2002). Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24, 555–565.
Reynolds JV, Daly JM, Zhang S (1988). Immunomodulatory mechanisms of arginine. Surgery 104, 141–151.
Riboli E, Kaaks R, Esteve J (1996). Nutrition and laryngeal cancer. Cancer Cause Control 7, 147–156.
Riso S, Aluffi P, Brugnani M, Farinetti F, Pia F, Dandrea F (2000). Postoperative enteral immunonutrition in head and neck cancer patients. Clin Nutr 19, 407–412.
Snyderman CH, Kachman K, Molseed L, Wagner R, D Amico F, Bumpous J et al. (1999). Reduced postoperative infections with an immne-enhancing nutritional supplement. Laryngoscope 109, 915–921.
Van Bokhorst-de van der Schueren MAE, von Blomberg-van-der Flier BME, Riezebos RK (1998). Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 17, 107–111.
Van Bokhorst-de van der Schueren MAE, van Leeuwen PAM, Sauerwein HP, Kuik DJ, Snow GB, Quak JJ (1997). Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19, 419–425.
Van Bokhorst-de van der Schueren MAE, Quak JJ, Von Blomberg-van der Flier ME, Kuik DJ, Langendoen SI, Snow GB et al. (2001). Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. Am J Clin Nutr 73, 323–332.
Weil E, Costecalde ME, Seguy D, Merrot O, Erb C, Chevalier D (2005). Perioperative evolution of the nutritional status in head and nek curgical patients. Prospective and descriptive case series. Ann Fr Anesth Reanim 24, 600–606.
Wilmore D (2004). Enteral and parenteral arginine supplementation to improve medical outcomes in hospitalized patients. Nutr 134, 2863–2867.
Wu GH, Zhang YW, Wu ZH (2001). Modulation of postoperaive immune and inflammatory response by immune-enhancing enteral diet in gastroientestinal cancer patients. World J Gastroenterol 7, 357–362.
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de Luis, D., Izaola, O., Cuellar, L. et al. Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients. Eur J Clin Nutr 61, 200–204 (2007). https://doi.org/10.1038/sj.ejcn.1602515
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DOI: https://doi.org/10.1038/sj.ejcn.1602515
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