TY - JOUR
T1 - Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients
AU - Van Bokhorst-De Van Der Schueren, Marian A.E.
AU - Quak, Jasper J.
AU - Von Blomberg-Van Der Flier, B. Mary E.
AU - Kuik, Dirk J.
AU - Langendoen, Sterre I.
AU - Snow, Gordon B.
AU - Green, Ceri J.
AU - Van Leeuwen, Paul A.M.
PY - 2001/2/12
Y1 - 2001/2/12
N2 - Background: Malnourished head and neck cancer patients are at increased risk of postoperative complications. Objective: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss > 10% of body weight) head and neck cancer patients undergoing major surgery. Design: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding. Results: Patients in both prefed groups received ≈9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1,2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor α and P = 0.042 for interleukin 6) at the start of the study than did patients who died. Conclusions: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.
AB - Background: Malnourished head and neck cancer patients are at increased risk of postoperative complications. Objective: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss > 10% of body weight) head and neck cancer patients undergoing major surgery. Design: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding. Results: Patients in both prefed groups received ≈9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1,2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor α and P = 0.042 for interleukin 6) at the start of the study than did patients who died. Conclusions: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.
KW - Cytokines
KW - Head and neck cancer
KW - Human leukocyte antigen-DR expression
KW - Malnutrition
KW - Perioperative nutrition
KW - Postoperative complications
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=0035143939&partnerID=8YFLogxK
M3 - Article
C2 - 11157331
AN - SCOPUS:0035143939
VL - 73
SP - 323
EP - 332
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
SN - 0002-9165
IS - 2
ER -