title: Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer: evaluation of inflammatory and immunologic outcomes.
abstract: Limited work is available on the benefits of nutritional support enriched with arginine and n-3 fatty acids in surgical patients with head and neck cancer, particularly if well-nourished. We conducted a pilot study in these patients to examine effects on inflammatory markers and clinical outcome. Patients scheduled for radical resection of the oral cavity were randomised to 5 day preoperative and 5 day postoperative Impact® (IMN, n = 4), or no preoperative supplementary nutrition and Isosource® postoperatively (STD, n = 4). Plasma fatty acids, C-reactive protein (CRP), tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were measured at baseline, day of surgery and on postoperative days (POD) 2, 4 and 10. Postoperative complications were recorded. The (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid ratio was significantly higher in IMN patients on POD 2, 4 and 10 (P < 0.01). While not statistically significant, CRP, TNF-α, and IL-6 concentrations were higher in the STD group on POD2 while IL-10 was lower. Median length of stay was 10 (range 10-43) days in the IMN group and 21.5 (7-24) days in the STD group. Five complications were seen in the STD group and two in the IMN group. The results support the need for a larger trial focusing on clinical outcome.
authors.affiliation: Department of Surgery, University of Auckland, Auckland 1142, New Zealand.
authors.forename: Amy
authors.initials: A
authors.lastname: Turnock
authors.forename: Philip C
authors.initials: PC
authors.lastname: Calder
authors.forename: Annette L
authors.initials: AL
authors.lastname: West
authors.forename: Mark
authors.initials: M
authors.lastname: Izzard
authors.forename: Randall P
authors.initials: RP
authors.lastname: Morton
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Plank
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000097:blood; D005260:Female; D006258:Head and Neck Neoplasms / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007121:Immunocompetence; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009752:Nutritional Status; D018529:Nutritional Support / Q000009:adverse effects / Q000379:methods; D019647:Oral Surgical Procedures / Q000009:adverse effects; D010865:Pilot Projects; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015525:Fatty Acids, Omega-3; D018836:Inflammation Mediators