Using preoperative nutritional supplements as part of ‘enhanced recovery’ in surgical patients is not a new concept. This interesting paper looks at the latest development in optimising patients undergoing head and neck oncological surgery. Immunonutrition (Nestle’s ‘Oral Impact’ in this study) is an oral high-calorie supplement containing additional omega-3, arginine and RNA-nucleotides, supposedly immune-modulating ingredients. Patients received this supplement three times daily for five days prior to their HNSCC curative-intent surgery. Compliance was closely recorded, with over 80% of patients taking >75% of the prescribed immunonutrition. This was a retrospective study, matching the 202 intervention group with a control group, although the intervention group had higher numbers of recurrent tumours and previous chemoradiotherapy (CRT).
The results of this study revealed that the immunonutrition group had a significantly reduced length of stay (LOS) and lower rates of local wound infection, abscess and fistulae. Patients who had better compliance had better LOS and complication outcomes, and there was a significant benefit in subgroups with previous CRT and extensive surgery.
This is the largest reported cohort using preoperative oral regimen in patients with head and neck surgery and, although a retrospective study, it promises to be an intervention which could have wider benefits such as reducing healthcare costs due to the positive outcomes seen here.