title: Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a systematic review.
abstract: BACKGROUND
  Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications.
  
  
  OBJECTIVE
  Some studies of patients receiving immuno-nutrition in the perioperative period in head and neck cancer have shown beneficial effects on clinical outcome and inmune status. The authors carried out a systematic review of randomised control trials to determine whether perioperative immunonutrition has a role in the treatment of head and neck cancer.
  
  
  METHODS
  14 trials of polymeric nutritional supplementation with immunonutrition were identified. Two studies compared two types of immunonutrition.
  
  
  RESULTS
  A reduction in the length of postoperative hospital stay was seen in some trials, but the reason for this reduction is not clear. Some studides showed statistical differences with less complications in arginine-enhanced group and also showed a significant decrease of fistula complications in patients treated with a high arginine dose enhanced formula, if compared with a medium dose of arginine.
  
  
  CONCLUSIONS
  [corrected] Those planning future studies face challenges. A suitable powered clinical trial is required before firm recommendations can be made on the use of immunonutrition in head and neck cancer patients postoperatively.
authors.affiliation: Department of Otorhinolaryngology, Complejo Asistencial Universitario de León, León, Spain. pablocasas2@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Casas Rodera
authors.forename: D A
authors.initials: DA
authors.lastname: de Luis
authors.forename: C
authors.initials: C
authors.lastname: Gómez Candela
authors.forename: J M
authors.initials: JM
authors.lastname: Culebras
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D006258:Head and Neck Neoplasms / Q000276:immunology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D044342:Malnutrition / Q000209:etiology / Q000628:therapy; D009752:Nutritional Status; D011184:Postoperative Period; D013534:Survival