| Problem. Head and neck cancer (HNCA) has one of the highest associated mortality rates of all cancers. Immune-modulating nutrition (IMN) support before and after surgery has the potential to promote host defense, antitumor activities, and wound healing.; Aims. The aim of this study was to establish the feasibility of providing perioperative IMN support to HNCA patients in a regional referral center. Recent studies have demonstrated that perioperative IMN support results in enhanced cell-mediated immunity, decreased infectious complications, and shortened postoperative hospital stay. Secondary aims will examine nutritional, immunologic, and wound healing outcomes.; Design. This pilot study used a prospective, blinded, randomized design.; Methods. Twelve patients with HNCA received either an IMN formula (Impact RecoverRTM/Impact GlutamineRTM ; TG) or a standard stress formula (Isosource 1.5RTM; CG) for a period of 7 days pre- and post-operatively. Nutritional outcomes, albumin and prealbumin, were measured at baseline and 4 later time points. Immunologic outcomes were measured by DTH skin testing twice, and TLC and lymphocyte subset counts at 5 time points. Wound healing was assessed using the ASEPSIS scoring tool and infectious complications were documented when present.; Results. Perioperative nutrition support was favorably accepted by patients and staff. Subjects did not vary in demographics at baseline except for C-reactive protein (CRP) levels; BMI (M=22; SD=3.8), % weight loss (M=9.1; SD=9.3), nutritional risk (M=2.27; SD=.65), and CRP (TG 6.87 + 8.3 vs. CG 39.5 + 13.8, p=.02). Based on diary entries the majority of patients consumed ≥75% of their preoperative nutritional supplement. CD56 (Natural Killer cells) demonstrated a more rapid return to baseline on POD 1 in the TG (p=.02). Wounds in the TG had less serous drainage and erythema on POD 3 (p=.05), POD 5 (p<.0001), and POD 6 (p=.01). Hospital LOS was considerably longer (TG M=5.7, CG M=14.7; p=0.04) in the CG; feeding issues postoperatively may have contributed to this outcome.; Conclusions. This pilot study provided crucial information regarding preoperative interventions, timing of biomarkers, and measurement of outcomes that can be used for planning a multisite RCT of perioperative immunonutrition for any surgical population vulnerable to nutritional and immunologic compromise. |
