Reduced infections with perioperative immunonutrition in head and neck cancer: Exploratory results of a multicenter, prospective, randomized, double-blind study

Summary Background & aims Head and neck cancer surgery is affected by complications in 20–60% of cases, with risk factors being malnutrition, alcoholism and immunosuppression due to cancer. The aim of the study was to investigate whether preoperative or perioperative immunonutrition could reduce postoperative infectious complications (IC) and surgical-site infections (SSI) in this population. Methods This was a multicenter, prospective, randomized, double-blind study. Patients with oropharyngeal and pharyngolaryngeal tumour were randomly allocated to three groups: a) perioperative formula of Impact ® without immune nutrients, named "reference diet" (group A, control); b) preoperative Impact ® and "reference diet" postoperatively (group B); c) Impact ® perioperatively (group C). Products were available in oral and enteral formula and were given 7 days before surgery and for 7–15 days postoperatively. The primary and secondary endpoints were the incidence of IC and SSI, respectively. Results Of 312 randomized patients, 205 were evaluable for ITT analysis. There was no significant difference in IC and SSI. However out of this population, only 64 patients had taken at least 75% of the theoretical intake from surgery to day 10 (per-protocol population). In this condition, a significant difference in IC (OR = 0.24, p  = 0.05), SSI (OR = 0.17, p  = 0.04) and also in the median length of postoperative stay (18 vs. 25 days, p  = 0.05) was demonstrated between groups A and C. Conclusions In the ITT population, no significant difference in IC, SSI and LOS was demonstrated. Positive exploratory results on the perioperative Impact ® per-protocol population, encourage further study in head and neck cancer patients. Registered under ClinicalTrials.gov Identifier no. NCT00765440.