Postoperative enteral immunonutrition in head and neck cancer patients.
OBJECTIVE
to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet.


METHODS
at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (> or = 10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded.


RESULTS
'visceral' serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05).


CONCLUSIONS
enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.
Riso
S
S
Clinical Nutrition Service, Maggiore della Carita Hospital, Novara, Italy.
Aluffi
P
P
Brugnani
M
M
Farinetti
F
F
Pia
F
F
D'Andrea
F
F
D001120:Arginine / Q000008:administration & dosage* / Q000627:therapeutic use; D004750:Enteral Nutrition; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000276:immunology / Q000517:prevention & control; D009752:Nutritional Status; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D013997:Time Factors; D016896:Treatment Outcome
D001120:Arginine