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. 2001 Feb;73(2):323-32. doi: 10.1093/ajcn/73.2.323.


Background: Malnourished head and neck cancer patients are at increased risk of postoperative complications.

Objective: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery.

Design: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding.

Results: Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died.

Conclusions: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arginine / administration & dosage
  • Arginine / therapeutic use*
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / immunology
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / therapy*
  • Dietary Supplements
  • Enteral Nutrition
  • Female
  • HLA-DR Antigens / immunology
  • Head and Neck Neoplasms / complications
  • Head and Neck Neoplasms / immunology
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Immune System / drug effects
  • Immune System / physiology*
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Morbidity
  • Nutrition Disorders / complications
  • Nutrition Disorders / therapy*
  • Nutritional Status / drug effects*
  • Perioperative Care
  • Postoperative Care
  • Prognosis
  • Survival Analysis
  • Time Factors
  • Tumor Necrosis Factor-alpha / analysis
  • Weight Loss


  • HLA-DR Antigens
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Arginine