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.
BACKGROUND
Malnourished head and neck cancer patients are at increased risk of postoperative complications.


OBJECTIVE
We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery.


METHODS
Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding.


RESULTS
Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died.


CONCLUSIONS
Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.
van Bokhorst-De Van Der Schueren
M A
MA
Department of Dietetics, the Nutrition Support Team, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. m.vanbokhorst@azu.nl
Quak
J J
JJ
von Blomberg-van der Flier
B M
BM
Kuik
D J
DJ
Langendoen
S I
SI
Snow
G B
GB
Green
C J
CJ
van Leeuwen
P A
PA
D000368:Aged; D001120:Arginine / Q000008:administration & dosage / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D006684:HLA-DR Antigens / Q000276:immunology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000502:physiology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009748:Nutrition Disorders / Q000150:complications / Q000628:therapy*; D009752:Nutritional Status / Q000187:drug effects*; D019990:Perioperative Care; D011182:Postoperative Care; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D015431:Weight Loss
D006684:HLA-DR Antigens; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D001120:Arginine