Perioperative immunonutrition in head and neck cancer.
OBJECTIVE
Immune-modulating nutrition (IMN) support before and after surgery has the potential to promote host defense, antitumor activities, and wound healing. The purpose of this study was to examine the nutritional, immunologic, and wound healing outcomes in patients receiving IMN versus standard formula.


METHODS
A prospective, blinded, randomized design was used for this study. Fifteen patients with head and neck squamous cell carcinoma received either an IMN formula (treatment group) or a standard stress formula (relative comparison group [RCG]) for a period of 7 days pre- and postoperatively.


METHODS
Albumin and prealbumin were measured at baseline, day of surgery (DOS), and postoperative day (POD) 1, 4, and 8. Immunologic outcomes included C-reactive protein and total lymphocyte count with lymphocyte subset counts (CD3, CD4, CD8, CD4:8 ratio, CD19, CD56) at baseline, DOS, POD1, 4, and 8. Cell-mediated immunity was evaluated by delayed-type hypersensitivity. Wound healing was assessed using the ASEPSIS tool.


RESULTS
CD3+ and CD4+ T cells demonstrated a significant difference between groups on POD 1 (P = .03 for both) and CD56 NK cells on POD 8 (P = .04). In general, wounds healed without complications except for tracheoesophageal fistula development in two patients in the RCG.


CONCLUSIONS
A trend toward less immune suppression in patients receiving IMN is supported in this study.
Sorensen
Douglas
D
Department of Surgery, Otolaryngology-Head and Neck Surgery Service, Madigan Army Medical Center, Tacoma, Washington 98431, USA. douglas.sorensen@us.army.mil
McCarthy
Mary
M
Baumgartner
Brian
B
Demars
Sean
S
D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000276:immunology* / Q000601:surgery*; D005260:Female; D005526:Food, Formulated; D006258:Head and Neck Neoplasms / Q000276:immunology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000276:immunology*; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects