Immunonutrition for patients undergoing surgery for head and neck cancer

• Published in: Cochrane database of systematic reviews 2018-08, Vol.8 (8), p.CD010954
• Main Authors: Howes, Noah, Atkinson, Charlotte, Thomas, Steven, Lewis, Stephen J
• Format: Article
• Language: English
• Subjects: Aged; Arginine - administration & dosage; Cancer; Cause of Death; Child health; Ear, nose & throat; Fatty Acids - administration & dosage; Fistula - epidemiology; Food, Fortified - adverse effects; Glutamine - administration & dosage; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - surgery; Humans; Length of Stay; Malignant disease; Malnutrition - etiology; Malnutrition - therapy; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Randomized Controlled Trials as Topic; Surgical Wound Infection - epidemiology
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010954.pub2

Patients with head and neck cancer are often malnourished. Surgery for such cancers is complex and may be undertaken after a course of radiotherapy. As a result, patients may have postoperative complications such as fistulae and wound infections, as well as more generalised infections such as pneumonia. One possible way to enhance recovery, and reduce the incidence of these complications, is by improving nutrition. Nutritional formulas that deliver basic nutrients as well as amino acids (arginine and glutamine), ribonucleic acid (RNA) and/or lipids (omega-3 fatty acids) are known as immunonutrition. To assess the effects of immunonutrition treatment, compared to standard feeding, on postoperative recovery in adult patients undergoing elective (non-emergency) surgery for head and neck cancer. The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 February 2018. We included randomised controlled trials (RCTs) comparing immunonutrition given either preoperatively, postoperatively or perioperatively to adult patients (18 years of age or older) undergoing an elective surgical procedure for head and neck cancer, compared with a control group receiving either standard polymeric nutritional supplements or no supplements. We used the standard methodological procedures expected by Cochrane. The primary outcomes were: length of hospital stay (days), wound infection, fistula formation and adverse events/tolerance of feeds, as defined by trial authors. Secondary outcomes were: all-cause mortality and postoperative complications (as defined by trial authors). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included 19 RCTs (1099 participants). The mean age of participants ranged from 47 to 66 years. Most studies (12/19) had fewer than 25 patients in each treatment group. Most studies (16/19) used immunonutrition formulas containing arginine, but there was variation in the actual products and amounts used, and in the length of intervention postoperatively. Follow-up time for outcome measurement varied considerably across studies, ranging from five days to greater than or equal to 16 months.Primary outcomesWe found no evidence of a difference in the length of hospital stay (mean difference -2