Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients.
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.


METHODS
Randomized clinical trial.


METHODS
Tertiary care.


METHODS
A population of 72 patients with oral and laryngeal cancer was enrolled.


METHODS
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.
de Luis
D A
DA
Medicine School and Unit of Investigation, Institute of Endocrinology and Nutrition, Hospital Rio Hortega, University of Valladolid, Valladolid, Spain. dadluis@yahoo.es
Izaola
O
O
Cuellar
L
L
Terroba
M C
MC
Martin
T
T
Aller
R
R
D001120:Arginine / Q000009:adverse effects / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition; D005260:Female; D005402:Fistula / Q000453:epidemiology* / Q000517:prevention & control; D006258:Head and Neck Neoplasms / Q000097:blood / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012709:Serum Albumin; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D014168:Transferrin / Q000378:metabolism; D016896:Treatment Outcome
D012709:Serum Albumin; D014168:Transferrin; D001120:Arginine