Postoperative enteral immunonutrition in head and neck cancer patients

Clin Nutr. 2000 Dec;19(6):407-12. doi: 10.1054/clnu.2000.0135.


Aims: to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet.

Methods: at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (> or = 10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded.

Results: 'visceral' serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05).

Conclusions: enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Arginine / administration & dosage*
  • Arginine / therapeutic use
  • Enteral Nutrition*
  • Female
  • Head and Neck Neoplasms / complications
  • Head and Neck Neoplasms / immunology
  • Head and Neck Neoplasms / surgery
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Length of Stay
  • Lymphocyte Count
  • Lymphocytes / blood
  • Lymphocytes / immunology
  • Male
  • Middle Aged
  • Nutrition Disorders / immunology
  • Nutrition Disorders / prevention & control
  • Nutritional Status
  • Postoperative Care*
  • Postoperative Complications / prevention & control
  • Postoperative Period
  • Time Factors
  • Treatment Outcome


  • Arginine