Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients

European Journal of Clinical Nutrition volume 61, pages 200–204 (2007)Cite this article

Abstract

Objective:

Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine-enhanced diet (17 g/day) than previous studies, could improve nutritional variables as well as clinical outcomes, when compared with a control enteral diet.

Design:

Randomized clinical trial.

Setting:

Tertiary care.

Subjects:

A population of 72 patients with oral and laryngeal cancer was enrolled.

Interventions:

At surgery, patients were randomly allocated to two groups: (a) 35 patients receiving an arginine-enhanced formula with arginine (group I) and (b) 37 patients receiving an isocaloric, isonitrogenous enteral formula (group II).

Results:

No significant intergroup differences in the trend of the three plasma proteins (albumin, transferrin, prealbumin) and lymphocytes were detected. Episodes of diarrhea rate were equal in both groups (22.8% group I and 21.6% group II: NS). The postoperative infections complications were equal in both groups (5.7% group I and 5.4% group II: NS). Fistula (wound complication) was less frequent in enriched nutrition group (2.8% group I and 18.9% group II: P<0.05), whereas wound infection was similar in both groups. The length of postoperative stay was similar in both (27.9±21 vs 28.2±12 days; NS).

Conclusions:

At this dose, arginine-enhanced formula improves fistula rates in postoperative head and neck cancer patients without a high rate of diarrhea.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Arriaga MA, Johnson JT, Kanel KT, Myers EN (1990). Medical complications in total laryngectomy: incidence and risk factors. Ann Otol Rhinol Laryngol 99, 611–615.

    Article  CAS  Google Scholar 

  • Bassett MR, Dobie RA (1990). Patterns of nutritional deficiency in head and neck cancer. Otol Head Neck Surg 91, 119–125.

    Article  Google Scholar 

  • Caparros T, Lopez J, Grau T (2001). Early enteral nutrition in critically ill patients with a high protein diet enriched with arginine, fiber and antioxidants compared with a standard high protein diet. The effect on nosocomial infections and outcome. J Parenter Enter Nut 25, 299–309.

    Article  CAS  Google Scholar 

  • Cummings JH (1983). Fermentation in the human large intestine: evidence and implications for health. Lancet 138, 1206–1209.

    Article  Google Scholar 

  • Daly JM, Reynolds J, Thom A (1998). Immune and metabolic effects of arginine in the surgical patient. Ann Surg 208, 521–523.

    Google Scholar 

  • de Luis DA, Aller R, Cabezas G, Terroba C, Cuellar L (2000). Estado nutricional en pacientes con tumores de cuello. Nutr Clin Diet 2, 21–26.

    Google Scholar 

  • De Luis DA, Aller R, Izaola O, Cuellar L, Terroba MC (2002). Postsurgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr 56, 1126–1129.

    Article  CAS  Google Scholar 

  • De Luis DA, Izaola O, Aller R, Cuellar L, Terroba MA (2004). Randomized clinical trial with an enteral arginine-enhanced formula in early postsurgical. Eur J Clin Nutr 58, 1505–1508.

    Article  CAS  Google Scholar 

  • Di Carlo V, Gianotti L, Balzano G, Zerbi A, Braga M (1999). Complications of pancreatic surgery and the role of perioperative nutrition. Dig Surg 16, 320–326.

    Article  CAS  Google Scholar 

  • Farreras N, Artigas V, Cardona D, Rius X, Trias M, Gonzalez JA (2005). Effect of early postoperative enteral inumnonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr 24, 55–65.

    Article  Google Scholar 

  • Gianoti L, Braga M, Fortis C, Soldini L, Vignali A, Clombo S et al. (1999). A prospective, randomized clinical trial on perioperative feeding with an arginine, omega-3 fatty acid, and RNA-enriched enteral diet. Effect on host response and nutritional status. J Parenter Enter Nutr 23, 314–320.

    Article  Google Scholar 

  • Goncalves Dias MC, de Fatima Nunes M, Nadalin W, Waitzberg DL (2005). Nutritional intervention improves the cloric and proteic ingestion of head and neck cancer patients under radiotherpy. Nutr Hosp 20, 320–325.

    CAS  PubMed  Google Scholar 

  • Martin Villares C, Fernandez ME, San Roman Carbajo J, Tapia Risueno M, Dominguez Calvo J (2003). Postoperative nutrition in patients with head and neck cancer. Nutr Hosp 18, 243–247.

    CAS  PubMed  Google Scholar 

  • Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A et al. (2002). Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24, 555–565.

    Article  Google Scholar 

  • Reynolds JV, Daly JM, Zhang S (1988). Immunomodulatory mechanisms of arginine. Surgery 104, 141–151.

    Google Scholar 

  • Riboli E, Kaaks R, Esteve J (1996). Nutrition and laryngeal cancer. Cancer Cause Control 7, 147–156.

    Article  CAS  Google Scholar 

  • Riso S, Aluffi P, Brugnani M, Farinetti F, Pia F, Dandrea F (2000). Postoperative enteral immunonutrition in head and neck cancer patients. Clin Nutr 19, 407–412.

    Article  CAS  Google Scholar 

  • Snyderman CH, Kachman K, Molseed L, Wagner R, D Amico F, Bumpous J et al. (1999). Reduced postoperative infections with an immne-enhancing nutritional supplement. Laryngoscope 109, 915–921.

    Article  CAS  Google Scholar 

  • Van Bokhorst-de van der Schueren MAE, von Blomberg-van-der Flier BME, Riezebos RK (1998). Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 17, 107–111.

    Article  Google Scholar 

  • Van Bokhorst-de van der Schueren MAE, van Leeuwen PAM, Sauerwein HP, Kuik DJ, Snow GB, Quak JJ (1997). Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19, 419–425.

    Article  CAS  Google Scholar 

  • Van Bokhorst-de van der Schueren MAE, Quak JJ, Von Blomberg-van der Flier ME, Kuik DJ, Langendoen SI, Snow GB et al. (2001). 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. Am J Clin Nutr 73, 323–332.

    Article  CAS  Google Scholar 

  • Weil E, Costecalde ME, Seguy D, Merrot O, Erb C, Chevalier D (2005). Perioperative evolution of the nutritional status in head and nek curgical patients. Prospective and descriptive case series. Ann Fr Anesth Reanim 24, 600–606.

    Article  Google Scholar 

  • Wilmore D (2004). Enteral and parenteral arginine supplementation to improve medical outcomes in hospitalized patients. Nutr 134, 2863–2867.

    Article  Google Scholar 

  • Wu GH, Zhang YW, Wu ZH (2001). Modulation of postoperaive immune and inflammatory response by immune-enhancing enteral diet in gastroientestinal cancer patients. World J Gastroenterol 7, 357–362.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medicine School and Unit of Investigation, Institute of Endocrinology and Nutrition, Hospital Rio Hortega, University of Valladolid, Valladolid, Spain

    D A de Luis, O Izaola, L Cuellar, M C Terroba & T Martin

  2. Hospital Rio Hortega, Hospital Clinico, University of Valladolid, Valladolid, Spain

    R Aller

Authors
  1. D A de Luis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O Izaola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Cuellar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M C Terroba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Aller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D A de Luis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Luis, D., Izaola, O., Cuellar, L. et al. Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients. Eur J Clin Nutr 61, 200–204 (2007). https://doi.org/10.1038/sj.ejcn.1602515

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602515

Keywords

This article is cited by

Search

Advanced search

Quick links