[Perioperative evolution of the nutritional status in head and neck surgical patients. Prospective and descriptive case series].
OBJECTIVE
To assess the perioperative evolution of the nutritional status of head and neck surgical patients.


METHODS
Prospective, descriptive case series.


METHODS
Fifty-four patients candidates for total or partial laryngectomy for malignancy of the neck tract without a past of neck surgery. The nutritional status of all patients hospitalized for total pharyngolaryngectomy, total or partial laryngectomy was assessed by 1) clinical parameters including weight (W), weight variation (WV, percentage of loss), Body Mass Index (BMI), triceps skin fold measurement (T), midarm circumference (M), and 2) biological parameters such as serum albumin (SA), transthyretin (TTR), lymphocytes (Ly). These parameters were noted at the time of diagnostic laryngoscopy (T1), the day before surgery (T2), and 10 days afterward (T3) when patients were authorized to eat normally. All patients had enteral nutrition (EN) support (35 kcal/kg/day) starting at D1 and for 10 days afterward. Only complete data per patient were analyzed.


RESULTS
24 patients were excluded. During the 21 days [7-53] preoperative period (T1-T2), WV was (6.6% [-8,1-+20.0] [T2] vs. 4.7% [-12,9-+20.0] [T1], p<0.05) without difference in T and M. In the postoperative period (T2-T3), all parameters worsened, except T, with: WV (8.2% [-8,1-+20.0] [T3], p<0.05 vs T2), M (27.4 cm [20.0-37.0] [T3] vs 28.3 cm [20.5-39.0] [T2], p<0.05) et TTR (0.21 mg/l [0.09-0.36] [T3] vs. 0.27 mg/l [0.08-0.45] [T2], p<0.05). BMI was 22.9 [15.2-36.7] (T1) vs 22.9 [15.2-35.3] (T2), NS and 22.1 [15.0-34.9] (T3), p<0.05 vs (T2).


CONCLUSIONS
The nutritional status in malignancy head and neck surgical patients seems to be best assessed by loss weight. It worsened mainly during the postoperative period even if a well-conducted EN was performed as defined by the French consensus conference.
Wiel
E
E
Clinique d'anesthésie-réanimation chirurgicale II, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France. e-wiel@chru-lille.fr
Costecalde
M E
ME
Séguy
D
D
Merrot
O
O
Erb
C
C
Chevalier
D
D
Vallet
B
B
D000328:Adult; D000368:Aged; D001132:Arm / Q000033:anatomy & histology; D015992:Body Mass Index; D001835:Body Weight; D004750:Enteral Nutrition; D005260:Female; D005602:France; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D007828:Laryngoscopy; D008214:Lymphocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D009752:Nutritional Status; D011228:Prealbumin / Q000378:metabolism; D011300:Preoperative Care; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism; D012885:Skinfold Thickness
D011228:Prealbumin; D012709:Serum Albumin