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.

Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinoma.
Aeberhard C, Mayer C, Meyer S, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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