Abstract
BackgroundPatients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma are at high risk of postoperative complications due to the adverse effects of radiotherapy on wound healing. Malnutrition is an additional risk factor and we tested the hypothesis that preoperative administration of immunonutrition would decrease complications in this high risk population.MethodsThis single armed study with historical control included consecutive patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma. We compared outcomes before and after implementation of preoperative immunonutrition and adjusted the regression analysis for gender, age, body mass index, Nutritional Risk Screening (NRS 2002), tobacco and alcohol consumption, tumor localization, tumor stage, and type of surgery. The primary endpoint was overall complications from surgery within a follow-up of 30 days.ResultsNinety-six patients were included (intervention group: 51, control group: 45). Use of preoperative immunonutrition was associated with a significant reduction in overall complications (35% vs. 58%, fully-adjusted odds ratio 0.30 (95%CI 0.10–0.91, p = 0.034). Length of hospital stay was also significantly reduced (17 days vs. 6 days, p = < 0.001). No differences in mortality and hospital readmission were found. These results remained robust in multivariate analysis.ConclusionsIn patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma, preoperative immunonutrition exhibited favorable effects on the complication rate and consequently reduced the length of hospital stay. By improving both tissue regeneration and immune response, immunonutrition may help to improve surgical outcomes in this high-risk population.
Highlights
Patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma are at high risk of postoperative complications due to the adverse effects of radiotherapy on wound healing
Mueller et al Journal of Otolaryngology - Head and Neck Surgery (2019) 48:25 recurrence or second primaries are at high risk for postoperative complications, with a total incidence of 40– 60% described in the literature [7,8,9,10,11]
Study design and population The study was conducted in accordance with the 1957 Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Canton of Bern, Switzerland (Ref. no. 256/2015). This is a single armed study with a historical control cohort and included patients undergoing salvage surgery for persistent/recurrent or second primary head and neck squamous cell carcinoma (HNSCC) after curatively intended RT, CRT or RT with concomitant immunotherapy (Cetuximab) for tumors arising in the oral cavity, oropharynx, hypopharynx, and larynx, as well as carcinoma of unknown primary (CUP) of the neck
Summary
Patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma are at high risk of postoperative complications due to the adverse effects of radiotherapy on wound healing. Fibrosis caused by fibroblast dysfunction and alterations in blood perfusion through microvascular damage lead to impaired wound healing and predispose for local complications [1]. Other side effects such as pain, dysgeusia, xerostomia, Given these unfavorable conditions, patients with HNSCC undergoing salvage surgery for tumor persistence/. Mueller et al Journal of Otolaryngology - Head and Neck Surgery (2019) 48:25 recurrence or second primaries are at high risk for postoperative complications, with a total incidence of 40– 60% described in the literature [7,8,9,10,11]. Length of hospital stay (LOS) may subsequently be extended and prognosis impaired [12]
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