Aeberhard Carla, Mayer Catherine, Meyer Simone, Mueller Simon Andreas, Schuetz Philipp, Stanga Zeno, Giger Roland
Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Head Neck. 2018 May;40(5):1057-1067. doi: 10.1002/hed.25072. Epub 2018 Jan 24.
Patients with head and neck squamous cell carcinoma (HNSCC) often acquire an impaired nutritional status resulting in compromised outcomes. Perioperative immunonutrition may have a positive effect on outcomes after elective surgery.
Short-term outcomes before and after implementation of preoperative immunonutrition were retrospectively assessed. Regression models adjusted for outcome predictors were used to compare the length of stay (LOS) in the hospital, local infections, and general complications.
Four hundred eleven patients were included (control group = 209 and the intervention group = 202). With immunonutrition, hospital LOS was significantly lower (median 6 vs 8 days; adjusted mean difference of -5.65 days; P < .001) and local infections were significantly reduced (7.4% vs 15.3%; adjusted odds ratio [OR] 0.30; P = .006). Subgroup analysis showed more pronounced effects in patients with previous radiotherapy and extensive surgery.
Patients receiving preoperative immunonutrition had a shorter hospital LOS and a lower rate for wound infections and local complications. These effects remained robust after a multivariate adjustment.
头颈部鳞状细胞癌（HNSCC）患者常出现营养状况受损，导致预后不良。围手术期免疫营养可能对择期手术后的预后产生积极影响。
回顾性评估术前免疫营养实施前后的短期预后。使用针对预后预测因素进行调整的回归模型比较住院时间（LOS）、局部感染和一般并发症。
纳入411例患者（对照组 = 209例，干预组 = 202例）。采用免疫营养后，住院LOS显著缩短（中位数6天对8天；调整后平均差异为 -5.65天；P <.001），局部感染显著减少（7.4%对15.3%；调整后比值比[OR] 0.30；P =.006）。亚组分析显示，既往接受过放疗和接受广泛手术的患者效果更明显。
接受术前免疫营养的患者住院LOS较短，伤口感染和局部并发症发生率较低。经过多变量调整后，这些效果依然显著。
