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Clin Nutr. 2014 Dec;33(6):951-7. doi: 10.1016/j.clnu.2014.04.020. Epub 2014 May 4.

Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: a systematic review and meta-analysis.

Author information

1
Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain. Electronic address: avcyo@hotmail.com.
2
Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain.

Abstract

INTRODUCTION:

Arginine improves healing and modulates inflammation and the immune response. A systematic review and meta-analysis were conducted to assess whether arginine-enriched enteral formulas reduce complications (fistulas, wound infections, other infections) and hospital length of stay (LoS) in patients undergoing surgery for head and neck cancer.

METHODS:

Medline, CENTRAL, and Trip Database were searched using the search strategy "Head and Neck Neoplasms" AND "Enteral Nutrition" AND "Arginine" OR "Immunonutrition". Inclusion criteria comprised: type of study (RCT), language (English, Spanish), outcomes (complications of surgery, LoS), and methodological quality (Jadad scale). The odds ratio (OR) and confidence intervals (95% CI) were calculated using the Mantel-Haenszel method, and the mean difference (MD) with the random effects method. Heterogeneity was assessed using Cochran's Q.

RESULTS:

Six studies were included, with 397 patients receiving peri/postoperative enteral nutrition with different doses of arginine (6.25-18.7 g/L). Enteral formulas containing arginine were associated with a reduction in fistulas [OR = 0.36 (95% CI 0.14-0.95), p = 0.039; Q = 3.93, p = 0.269], and LoS [MD = -6.8 (95% CI -12.6 to -0.9) days, p = 0.023; Q = 2.44, p = 0.486]. There were no reductions in wound infections [OR = 1.04 (95% CI 0.49-2.17), p = 0.925; Q = 1.60, p = 0.809] or other infections [OR = 0.79 (95% CI 0.48-1.31); p = 0.369; Q = 7.94, p = 0.094]. Arginine administration did not increase the occurrence of diarrhoea [OR = 1.80 (95% CI 0.50-6.52), p = 0.375; Q = 0.16, p = 0.691].

CONCLUSIONS:

The administration of arginine-enriched enteral nutrition led to a significant reduction in fistulas and hospital stay in patients undergoing surgery for head and neck cancer.

KEYWORDS:

Arginine; Enteral nutrition; Head and neck cancer; Immunonutrition; Meta-analysis; Systematic review

PMID:
24844870
DOI:
10.1016/j.clnu.2014.04.020
[Indexed for MEDLINE]

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