Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients

Objective: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine-enhanced diet ( 17 g/day) than previous studies, could improve nutritional variables as well as clinical outcomes, when compared with a control enteral diet. Design: Randomized clinical trial. Setting: Tertiary care. Subjects: A population of 72 patients with oral and laryngeal cancer was enrolled. Interventions: At surgery, patients were randomly allocated to two groups: ( a) 35 patients receiving an arginine-enhanced formula with arginine ( group I) and (b)37 patients receiving an isocaloric, isonitrogenous enteral formula ( group II). Results: No significant intergroup differences in the trend of the three plasma proteins ( albumin, transferrin, prealbumin) and lymphocytes were detected. Episodes of diarrhea rate were equal in both groups (22.8% group I and 21.6% group II: NS). The postoperative infections complications were equal in both groups (5.7% group I and 5.4% group II: NS). Fistula ( wound complication) was less frequent in enriched nutrition group (2.8% group I and 18.9% group II: P < 0.05), whereas wound infection was similar in both groups. The length of postoperative stay was similar in both (27.9721 vs 28.2712 days; NS). Conclusions: At this dose, arginine-enhanced formula improves fistula rates in postoperative head and neck cancer patients without a high rate of diarrhea.