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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^1,2,3

¹ From the Department of Dietetics, the Nutrition Support Team, the Department of Otolaryngology/Head and Neck Surgery, the Department of Pathology, and the Department of Surgery, University Hospital Vrije Universiteit, Amsterdam; the Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit, Amsterdam; and the Medical Information Department, Numico Nutritional Healthcare, Zoetermeer, Netherlands.

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 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.

Key Words: Head and neck cancer • malnutrition • perioperative nutrition • human leukocyte antigen-DR expression • cytokines • postoperative complications • survival

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