Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a systematic review.

INTRODUCTION: 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. OBJECTIVES: 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. CONCLUSION: [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.

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery; a systematic review / Fórmulas de inmunonutrición enteral en la cirugía del cáncer de cabeza y cuello; una revisión sistemática

Introduction: 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. Objectives: 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. Conclussion: 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 posto-peratively (AU)

Introducción: Un alto porcentaje de pacientes con cáncer de cabeza y cuello presentan un importante grado de malnutrición. Esta malnutrición está asociada defectos de la función inmune. Tanto la malnutrición como la inmunosupresión hacen a estos pacientes susceptibles de padecer complicaciones infecciosas en el postoperatorio. Objetivos: Algunos trabajos de pacientes que han recibido inmunonutrición en el postoperatorio de cirugía por cáncer de cabeza y cuello han mostrado un efecto beneficioso en la evolución clínica y el estado inmune. Los autores han llevado a cabo una revisión sistemática de los ensayos clínicos realizados hasta la fecha, para determinar el papel que tiene la inmunonutrición enteral postoperatoria en el tratamiento del cáncer de cabeza y cuello. Métodos: Se identificaron 14 trabajos en los que se habían utilizado fórmulas de inmunonutrición. Dos trabajos compararon dos tipos de inmunonutrición. Resultados: En algunos trabajos se observó una disminución en los días de estancia hospitalaria, aunque la razón para ello no está clara. Algunos estudios mostraron diferencias significativas con menos complicaciones en los grupos que recibieron nutriciones enriquecidas, presentando una disminución significativa en el número de fístulas en pacientes tratados con nutriciones con altas dosis de arginina, si se compara con una nutrición con una dosis media de arginina. Conclusión: Los futuros trabajos presentan retos. Es necesario un ensayo clínico extenso, para poder realizar recomendaciones firmes sobre el uso de la inmunonutrición en el postoperatorio de pacientes intervenidos de cáncer de cabeza y cuello (AU)

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a prospective, randomized clinical trial.

INTRODUCTION: 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. OBJECTIVES: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. PATIENTS: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. RESULTS: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 +/- 8 days. The length of postoperative stay was similar, with an average of 19,8 +/- 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFalpha were detected. The control group showed the highest levels of TNFalpha at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. CONCLUSIONS: Immunoenhanced enteral nutrition formulas improved the infection rate in the postoperative of head and neck cancer patients. In the fistula rates, we observed that technical problems and nutritional status might have played an equally important role, and therefore the positive effect of immunonutrition in this parameter might have been overestimated.

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a prospective, randomyzed clinical trial / Fórmulas de nutrición enteral inmuno-enriquecidas en la cirugía del cáncer de cabeza y cuello. Ensayo prospectivo y aleatorizado

Introduction: 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. Objectives: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. Patients: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. Results: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 ± 8 days. The length of postoperative stay was similar, with an average of 19,8 ± 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFα were detected. The control group showed the highest levels of TNFα at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. Conclusions: Immunoenhanced enteral nutrition formulas improved the infection rate in the postoperative of head and neck cancer patients. In the fistula rates, we observed that technical problems and nutritional status might have played an equally important role, and therefore the positive effect of immunonutrition in this parameter might have been overestimated (AU)

Introducción: Un alto porcentaje de pacientes con cáncer de cabeza y cuello presentan un importante grado de malnutrición. Esta malnutrición está asociada defectos de la función inmune. Tanto la malnutrición como la inmunosupresión hacen a estos pacientes susceptibles de padecer complicaciones infecciosas en el postoperatorio. Objetivos: Comparar 2 inmunonutriciones enterales con una dieta control, y evaluar el efecto en las infecciones postoperatorias, duración de la estancia hospitalaria y marcadores de inflamación. Pacientes: Se realizó un estudio aleatorizado en un grupo de 44 pacientes con cáncer de cavidad oral y laringe. En el momento de la cirugía los pacientes fueron aleatoriamente asignados a 3 grupos diferentes: (grupo I), pacientes que recibieron una nutrición enriquecida con arginina (grupo II); pacientes que recibieron una nutrición isocalórica, isonitrogenada, y (grupo III), pacientes que recibieron una nutrición enriquecida con arginina, nucleótidos y ácidos grasos omega 3. Resultados: La duración de la nutrición enteral fue similar en los 3 grupos, con una media de 14,5 ± 8 días. La duración de la estancia hospitalaria fue similar, con una media de 19,8 ± 8,5 días. Las infecciones de la herida quirúrgica y las infecciones generales fueron más frecuentes en el grupo control. El porcentaje de fístulas no mejoró en los grupos con nutriciones enriquecidas. No se observaron diferencias significativas entre los grupos en cuanto a la tendencia de las proteínas plasmáticas (albúmina y transferrina), linfocitos, peso, ni IL-6, CPR y TNFα. El grupo control mostró los niveles más altos de TNFα al decimocuarto día del postoperatorio. La tolerancia gastrointestinal (diarrea) fue similar en todos los pacientes. Conclusiones: Las inmunonutriciones enterales disminuyeron el número de infecciones generales en el postoperatorio de pacientes con cáncer de cabeza y cuello. En cuanto al porcentaje de fístulas faringocutáneas no observamos disminución en los grupos con nutriciones enriquecidas. Por lo que pensamos que la técnica quirúrgica y el estado nutricional tienen una importancia similar y por ello en este parámetro el efecto positivo de la inmunonutrición puede estar sobrevalorado (AU)