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Yen YH, Luo SD, Chen WC, Li CY, Chiu TJ, Wang YM, Wu SC, Yang YH, Chen YH, Wu CN. The Value of the Nutritional Indicators in Predicting Free Flap Failure From a Multicentre Database. Otolaryngol Head Neck Surg 2024; 171:63-72. [PMID: 38501382 DOI: 10.1002/ohn.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Nutritional and inflammatory statuses have been associated with complications in microvascular-free flaps during head and neck surgeries. This study aimed to evaluate the potential of nutritional indicators in predicting postoperative free flap complications. STUDY DESIGN We conducted a 20-year retrospective, case-control study within a defined cohort. SETTING The study involved head and neck cancer patients from the Chang Gung Research Database who underwent simultaneous tumor ablation and free flap wound reconstruction between January 1, 2001, and December 31, 2019. METHODS We employed logistic regression and stratified analysis to assess the risk of free flap complications and the subsequent need for flap revision or redo in relation to nutritional indicators and other clinical variables. RESULTS Of the 8066 patients analyzed, 687 (8.5%) experienced free flap complications. Among these, 197 (2.4%) had free flap failures necessitating a redo of either a free flap or a pedicled flap. Beyond comorbidities such as chronic obstructive pulmonary disease, end-stage renal disease, and a history of prior radiotherapy, every 10-unit decrease in the preoperative prognostic nutritional index (PNI) was consistently associated with an increased risk of both free flap complications and failure. The covariate-adjusted odds ratios were 1.90 (95% confidence interval [CI]: 1.42-2.54) and 1.89 (95% CI: 1.13-3.17), respectively. CONCLUSION A lower preoperative PNI suggests a higher likelihood of microvascular free flap complications in head and neck surgeries. Further randomized controlled trial designs are required to establish causality.
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Affiliation(s)
- Yuan-Hao Yen
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Health care Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Tai-Jan Chiu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Hsuan Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nieminen T, Tapiovaara L, Bäck L, Lindford A, Lassus P, Lehtonen L, Mäkitie A, Keski-Säntti H. Enhanced recovery after surgery (ERAS) protocol improves patient outcomes in free flap surgery for head and neck cancer. Eur Arch Otorhinolaryngol 2024; 281:907-914. [PMID: 37938375 PMCID: PMC10796721 DOI: 10.1007/s00405-023-08292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND In recent years, enhanced recovery after surgery (ERAS) guidelines have been developed to optimize pre-, intra-, and postoperative care of surgical oncology patients. The aim of this study was to compare management outcome of patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction at our institution before and after the implementation of the ERAS guidelines. METHODS This retrospective study comprised 283 patients undergoing HNC surgery with free flap reconstruction between 2013 and 2020. Patients operated before and after the implementation of the ERAS protocol in October 2017 formed the pre-ERAS group (n = 169), and ERAS group (n = 114), respectively. RESULTS In the pre-ERAS group the mean length of stay (LOS) and intensive care unit length of the stay (ICU-LOS) were 20 days (range 7-79) and 6 days (range 1-32), and in the ERAS group 13 days (range 3-70) and 5 days (range 1-24), respectively. Both LOS (p < 0.001) and ICU-LOS (p = 0.042) were significantly reduced in the ERAS group compared to the pre-ERAS group. There were significantly fewer medical complications in the ERAS group (p < 0.003). No difference was found between the study groups in the surgical complication rate or in the 30-day or 6-month mortality rate after surgery. CONCLUSIONS We found reduced LOS, ICU-LOS, and medical complication rate, but no effect on the surgical complication rate after implementation of the ERAS guidelines, which supports their use in major HNC surgery.
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Affiliation(s)
- Teija Nieminen
- Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029 HUS, Helsinki, Finland.
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Laura Tapiovaara
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lasse Lehtonen
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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3
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Liu S, Wang R, Fang J. Exploring the frontiers: tumor immune microenvironment and immunotherapy in head and neck squamous cell carcinoma. Discov Oncol 2024; 15:22. [PMID: 38294629 PMCID: PMC10830966 DOI: 10.1007/s12672-024-00870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
The global prevalence of head and neck malignancies positions them as the sixth most common form of cancer, with the head and neck squamous cell carcinoma (HNSCC) representing the predominant histological subtype. Despite advancements in multidisciplinary approaches and molecular targeted therapies, the therapeutic outcomes for HNSCC have only marginally improved, particularly in cases of recurrent or metastatic HNSCC (R/MHNSCC). This situation underscores the critical necessity for the development of innovative therapeutic strategies. Such strategies are essential not only to enhance the efficacy of HNSCC treatment but also to minimize the incidence of associated complications, thus improving overall patient prognosis. Cancer immunotherapy represents a cutting-edge cancer treatment that leverages the immune system for targeting and destroying cancer cells. It's applied to multiple cancers, including melanoma and lung cancer, offering precision, adaptability, and the potential for long-lasting remission through immune memory. It is observed that while HNSCC patients responsive to immunotherapy often experience prolonged therapeutic benefits, only a limited subset demonstrates such responsiveness. Additionally, significant clinical challenges remain, including the development of resistance to immunotherapy. The biological characteristics, dynamic inhibitory changes, and heterogeneity of the tumor microenvironment (TME) in HNSCC play critical roles in its pathogenesis, immune evasion, and therapeutic resistance. This review aims to elucidate the functions and mechanisms of anti-tumor immune cells and extracellular components within the HNSCC TME. It also introduces several immunosuppressive agents commonly utilized in HNSCC immunotherapy, examines factors influencing the effectiveness of these treatments, and provides a comprehensive summary of immunotherapeutic strategies relevant to HNSCC.
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Affiliation(s)
- Shaokun Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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4
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Seth I, Bulloch G, Qin KR, Xie Y, Sebastian B, Liew H, Rozen WM, Lee CHA. Pre-rehabilitation interventions for patients with head and neck cancers: A systematic review and meta-analysis. Head Neck 2024; 46:86-117. [PMID: 37897197 DOI: 10.1002/hed.27561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate the effect of pre-rehabilitation interventions such as nutrition and exercise for patients with head and neck cancer (HNC). METHODS Web of Science, PubMed, Scopus, Google Scholar, and Cochrane databases were searched up to December 2022. Quality of life, length of hospital stay, postoperative complications, change in body mass index or muscle mass, and functional assessments were the primary outcomes. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The Cochrane Collaboration tool and Newcastle Ottawa scale assessed the quality of included studies. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan5.4. RESULTS A total of 31 articles were included for quantitative analysis and 15 for qualitative synthesis. Nutrition alone resulted in significant weight retention (2.60; 2.32, 2.88, p < 0.00001), length of stay (-4.00; -6.87, -1.13), p = 0.0006) and complications (0.64; 0.49, 0.83, p = 0.0009). Nutrition and psychoeducation resulted in a significant reduction in mortality rate (0.70; 0.49, 1.00, p = 0.05 and 0.60; 0.48, 0.74, p < 0.00001), and exercise resulted in a significant reduction in dysphagia (0.55; 0.35, 0.87, p = 0.01). Exercise with nutrition resulted in significant improvements in weight loss, length of stay, complications, and dysphagia. Randomized controlled trials (RCTs) had a moderate risk of bias and cohort studies were of fair to good quality. CONCLUSION Prehabilitation programs based on exercise, nutrition, or psychoeducation demonstrated improved post-interventional outcomes in HNC, such as quality of life, and mortality and morbidity. Studies with longer follow-ups and larger sample sizes, and investigations comparing nutritional supplements with exercise programs are needed.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Gabriella Bulloch
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirby R Qin
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Yi Xie
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | | | - Hann Liew
- Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chun Hin Angus Lee
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Bissinger O, Von den Hoff A, Maier E, Obermeier KT, Stimmer H, Kolk A, Wolff KD, Götz C. The Value of Surveillance Imaging of Oral Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:207. [PMID: 38201635 PMCID: PMC10778242 DOI: 10.3390/cancers16010207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
The evaluation of surveillance imaging of OSCC patients is a difficult task physicians have to face daily. Multiple patients experience a recurrence of this disease, which underlines the importance of regular patient monitoring programs. Our study analysed the value of surveillance imaging, such as computed tomography (CT) and nuclear magnetic resonance imaging (NMRI), as a patient monitoring programme and its effectiveness in achieving improvement in early recurrence detection. The study comprised 125 patients, out of which 56 (n = 56) showed radiological and 69 (n = 69) showed clinical and radiological conspicuous patterns in domestic follow-ups, respectively. The use of CT and NMRI showed a significant dependence on the histological result (p = 0.03). However, the different groups showed no significant dependence on the histological result (p = 0.96). The distribution of the histological biopsies, which were taken due to radiological changes, were prone to wrong positive diagnoses (false positives) in 71 percent. To conclude, imaging modalities should be chosen for each patient individually to reduce false positives, improve the early detection of recurrence, and increase the cure rate.
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Affiliation(s)
- Oliver Bissinger
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria (C.G.)
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Anne Von den Hoff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Elisabeth Maier
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria (C.G.)
| | - Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Lindwurmstraße 2A, 80337 Munich, Germany
| | - Herbert Stimmer
- Department of Radiology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria (C.G.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Carolin Götz
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria (C.G.)
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
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6
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Ciernikova S, Sevcikova A, Stevurkova V, Mego M. Diet-driven microbiome changes and physical activity in cancer patients. Front Nutr 2023; 10:1285516. [PMID: 38075222 PMCID: PMC10704146 DOI: 10.3389/fnut.2023.1285516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 04/13/2024] Open
Abstract
Exploring the role of the gut microbiome in oncology is gaining more attention, mainly due to its ability to shape the immune system in cancer patients. A well-balanced microbial composition forms a symbiotic relationship with the host organism. Mounting evidence supports the potential of modifiable lifestyle factors, such as diet and physical activity, in restoring intestinal dysbiosis related to cancer development and treatment. In this Minireview, we describe the host-microbiome interplay following different dietary patterns, including a high-fat diet, fiber-rich diet, diet rich in rice and beans, Mediterranean diet, ketogenic diet, and physical activity in preclinical findings and clinical settings. According to the results, nutrition is a critical factor influencing the composition of gut microbial communities. Therefore, knowledge about the patient's nutritional status in pre-treatment and treatment becomes crucial for further management. A combination of individualized dietary habits and professional training plans might help to maintain gut homeostasis, potentially improving the response to anti-cancer therapy and the quality of life in cancer survivors. However, a deep understanding of underlying mechanisms and large clinical trials are needed to uncover clinically relevant correlations for personalized treatment approaches leading to better outcomes for cancer patients.
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Affiliation(s)
- Sona Ciernikova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Aneta Sevcikova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Viola Stevurkova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Bratislava and National Cancer Institute, Comenius University, Bratislava, Slovakia
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7
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The effect of short-term preoperative nutritional intervention for cleft surgery eligibility. BMC Nutr 2023; 9:47. [PMID: 36918940 PMCID: PMC10012294 DOI: 10.1186/s40795-023-00704-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. METHODS A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). RESULTS A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001). CONCLUSION Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care.
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Ascoli A, Missale F, Giordano GG, Vallin A, Gradaschi R, Guiddo E, Schenone G, Sukkar SG, Copello F, Parrinello G, Iandelli A, Peretti G, Marchi F. Immunonutrition in major oncologic head and neck surgery: Analysis of complications, plasmatic equilibrium, and costs. Head Neck 2023; 45:449-463. [PMID: 36490206 DOI: 10.1002/hed.27270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Malnutrition, in patients with solid tumors, is associated with a worse clinical outcome and about 40% of patients affected by head and neck cancers (HNC) are malnourished at the time of cancer diagnosis. We investigated the potential benefit of a standardized immunonutritional protocol (INP) to patients with HNC receiving major ablative surgery. METHODS An observational study was conducted enrolling 199 patients: 50 treated with the INP and 149 with standard enteral nutrition. Complication rates, need for medications, and costs were considered as outcomes. RESULTS INP played a protective role in development of major surgical complications (OR 0.23, p = 0.023), albumin administration (RR 0.38, p = 0.018), and antibiotic duration (p < 0.001) and is cost-effective in patients with moderate or severe malnutrition (-6083€ and -11 988€, p < 0.05). CONCLUSIONS Our study supports the utility of INP, and accurate nutritional screening can help to identify malnourished patients who would receive the most benefits from this protocol.
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Affiliation(s)
- Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Giorgio-Gregory Giordano
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alberto Vallin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Raffaella Gradaschi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Erica Guiddo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | | | - Samir Giuseppe Sukkar
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Francesco Copello
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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Okada T, Mikamo T, Hamamoto W, Iwamoto T, Okamoto T, Maeda K, Yanagitani A, Tanaka K, Isomoto H, Yamaguchi N. Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors. Cancers (Basel) 2022; 14:cancers14225555. [PMID: 36428648 PMCID: PMC9688376 DOI: 10.3390/cancers14225555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.
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Affiliation(s)
- Tomoyuki Okada
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
- Correspondence: ; Tel.: +0857-26-2271
| | - Tsuyoshi Mikamo
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Wataru Hamamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Taku Iwamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kazunori Maeda
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kiwamu Tanaka
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, Nagasaki 852-8501, Japan
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10
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Nett H, Steegmann J, Tollkühn-Prott B, Hölzle F, Modabber A. A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancer. Sci Rep 2022; 12:14213. [PMID: 35987809 PMCID: PMC9392772 DOI: 10.1038/s41598-022-18292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Extensive surgical treatment of oral cancer results in significant deterioration of nutritional status with concomitant increased nutrient requirements. The consequences are an elevated risk of postoperative complaints as well as morbidity and mortality. The aim of this study was to investigate an additional postoperative nutritional intervention through professional nutritional advice and nutritional supplementation in patients with oral cancer for at least six months. 62 patients with oral cancer in the department of oral and maxillofacial surgery were randomized into two groups. The intervention group received nutritional supplements, protein-rich, high-fiber diet and care by a professional nutritionist in addition to the standard treatment. The control group received only the standard treatment. Statistical analysis includes the evaluation of means and standard deviations as well as the calculation of p values with a significance level of 0.05. A deficiency of protein, albumin, vitamin D, zinc and iron was noticed in both groups immediately after surgery. Patients in the intervention group recorded significantly less weight loss (pT2 = 0.0031, pT4 = 0.0424), a more stable BMI (pT2 = 0.0496), better values for albumin (pT2 = 0.0265), vitamin A (pT3 = 0.0248, pT4 = 0.0007) and calcium (pT3 = 0.0362) during the follow-ups. The patients in the intervention group showed significantly fewer digestive problems (p = 0.0062) and muscular complaints (p = 0.0448). They showed better eating habits (p = 0.0348) and were capable of more physical activity (p = 0.0045) than patients in the control group. Patients with oral cancer can have a benefit from postoperative nutritional intervention. Early screening, appropriate care by a nutritionist and supplementation with vitamin D, zinc, calcium and protein-rich food are recommended.
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11
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Caccialanza R, Laviano A, Bosetti C, Nardi M, Casalone V, Titta L, Mele R, De Pergola G, De Lorenzo F, Pedrazzoli P. Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Support Care Cancer 2022; 30:9667-9679. [PMID: 35792925 DOI: 10.1007/s00520-022-07269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Malnutrition is a common clinical and public health problem that can frequently affect patients in hospital and community settings. In particular, cancer-related malnutrition results from a combination of metabolic dysregulation and anorexia, caused both by the tumor itself and by its treatment. Patients with head-neck cancer, or with gastroesophageal, pancreatic, lung, and colorectal cancer, are particularly at risk of developing malnutrition, with a prevalence varying between 30 and 50% depending on tumor location and anti-cancer treatment complications. Prevention and adequate management of malnutrition is now considered an essential key point of therapeutic pathways of patients with cancer, with the aim to enhance their quality of life, reduce complications, and improve clinical outcomes. Oral nutritional supplements (ONS) are part of the nutritional therapy and represent an effective tool to address cancer-related malnutrition, as supported by growing literature data. However, patients' access to ONS - which is regulated by different national and regional policies in terms of reimbursement - is quite heterogeneous. This narrative review aims to summarize the current knowledge about the role of ONS in terms of cost-effectiveness in the management of actively treated patients with cancer, following surgery and/or radiotherapy/chemotherapy treatment and to present the position on this issue of the Alliance Against Cancer, the Italian National Oncology Network, coming up from a focused virtual roundtable of the Survivorship Care and Nutritional Support Working Group.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Bosetti
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Casalone
- Clinical Nutrition and Dietetics Unit, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Lucilla Titta
- Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Mele
- Hospital Health Direction, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
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12
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Yung AE, Wong G, Pillinger N, Wykes J, Haddad R, McInnes S, Palme CE, Hubert Low TH, Clark JR, Sanders R, Ch'ng S. Validation of a risk prediction calculator in Australian patients undergoing head and neck microsurgery reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:3323-3329. [PMID: 35768291 DOI: 10.1016/j.bjps.2022.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) is an open access calculator predicting patients' risk of postoperative complications. This study aims to assess the validity of the SRC in patients undergoing microsurgical free flap reconstruction at an Australian tertiary referral centre. METHODS This is a retrospective cohort study of 200 consecutive patients treated up to November 2020. SRC-predicted rates of postoperative complications and hospital length of stay (LOS) were compared to those observed for the ablative and reconstructive components of the procedure. The performance of the SRC was assessed using Brier scores, area under the receiver operating characteristic (ROC) curve (AUC), and the Hosmer-Lemeshow test. RESULTS For both ablative and reconstructive components, the SRC discriminates well for pneumonia and urinary tract infection, and it is calibrated well for readmission and sepsis, but it does not discriminate and calibrate well for any single outcome. SRC-predicted hospital LOS and actual LOS did not correlate well for the reconstructive component, but they correlated strongly for the ablative component. CONCLUSIONS The SRC is a poor predictor of postoperative complication rates and hospital LOS in patients undergoing head and neck microsurgical reconstruction.
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Affiliation(s)
- Amanda E Yung
- The University of Sydney Sydney Medical School, Sydney, Australia; The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia
| | - Gerald Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil Pillinger
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Roger Haddad
- Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephanie McInnes
- Department of Anaesthetics, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Jonathan R Clark
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Robert Sanders
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sydney Ch'ng
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute of Australia, Sydney, Australia.
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13
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Daher GS, Choi KY, Wells JW, Goyal N. A Systematic Review of Oral Nutritional Supplement and Wound Healing. Ann Otol Rhinol Laryngol 2022; 131:1358-1368. [PMID: 35043693 DOI: 10.1177/00034894211069437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the current literature for effects of oral nutritional supplement on wound healing rates in humans. METHODS A systematic review of the literature was performed using the Medline and PubMed database following PRISMA guidelines. The PubMed database was searched using terms relating to oral nutritional supplement and wound healing from 1837 to March 2020. Study inclusion criteria were: (i) design: randomized controlled trials, clinical studies, observational studies, clinical trials; (ii) population: adults; and (iii) intervention: oral nutritional supplement. RESULTS The search yielded 2433 studies, 313 of which were clinical trials or clinical studies. After abstract review, 28 studies qualified to be included in the review evaluating the following supplementation categories on wound healing: protein and amino acids (10), mineral, vitamin and antioxidants (9), probiotics (1), and mixed nutrients (8). Arginine and omega-3 supplement were shown to improve wound healing in head and neck cancer patients with surgical wounds by decreasing incidence of postoperative complications and reducing length of hospital stay. Mineral, vitamins, and antioxidants enriched supplements were more beneficial in increasing wound healing than non-enriched protein supplement for diabetic foot and pressure ulcers. CONCLUSIONS Supplementation of a variety of nutrients had variable effects on improving wound healing in different types of wounds. However, further research on the impact of nutritional supplements on surgical wound healing is necessary. The impact of multiple nutrient formulations may also need to be further evaluated for efficacy.
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Affiliation(s)
- Ghazal S Daher
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Karen Y Choi
- Department of Otolaryngology - Head and Neck Surgery, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffery W Wells
- Department of Otolaryngology - Head and Neck Surgery, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology - Head and Neck Surgery, Milton S. Hershey Medical Center, Hershey, PA, USA
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14
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Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS. Poor treatment tolerance in head and neck cancer patients with low muscle mass. Head Neck 2022; 44:844-850. [PMID: 35020252 DOI: 10.1002/hed.26978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). METHODS A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. RESULTS One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders. CONCLUSION Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Terral Patel
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Gardiner
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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15
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Arolkar P, Damle G, Gala P. Role of nutrition in pediatric patients with respiratory failure. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Chen J, Dennis SK, Abouyared M. Sarcopenia and microvascular free flap reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29:419-423. [PMID: 34387288 DOI: 10.1097/moo.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recent literature regarding the impact of sarcopenia on microvascular free flap reconstruction outcomes. RECENT FINDINGS Malnutrition, and consequent muscle loss, is a prevalent issue among head and neck cancer patients. However, diagnosis remains challenging due to a paucity of reliable objective measures. Traditional markers, such as albumin, have been used in the past to assess nutritional status, but cancer-related inflammation limits their predictive value. Recently, developments in the diagnosis of sarcopenia through the novel use of computed tomography (CT) cross-sectional muscle mass indices to evaluate body composition have proven effective and accessible. SUMMARY Literature shows compelling evidence that sarcopenia is associated with higher rates of surgical complications that delay recovery and increase mortality. The use of CT imaging to quantify muscle loss offers an objective way to evaluate nutritional status, which is predictive of postoperative rates of complications. Research on ways to optimize muscle mass prior to surgery is limited, however, immunonutrition is emerging as a promising intervention that can attenuate sarcopenia-related inflammation to improve outcomes.
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Affiliation(s)
- Joy Chen
- Department of Otolaryngology, University of California, Sacramento, California, USA
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17
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Gonçalves KKN, de Araújo ESM, Barbirato DS, do Lago CAP, do Egito Vasconcelos BC. Head and neck cancer associated with myiasis. Int J Oral Maxillofac Surg 2021; 51:847-853. [PMID: 34602319 DOI: 10.1016/j.ijom.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/21/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Head and neck cancer patients represent a risk group for the development of fly larvae infestation in neoplastic wounds. This condition can accelerate the disease progression and increase its lethality due to local or systemic complications. The aim of this study was to conduct a scoping review on head and neck cancer associated with myiasis in order to answer the focal question: what are the occurrence, diagnosis, aetiology, treatment and outcomes of head and neck cancer associated with myiasis? This paper was structured based on the five-steps methodology proposed by Arksey and O'Malley (Int J Soc Res Methodol 2005;1:19-32), and followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR), OSF Registries protocol. The electronic search was performed in the MEDLINE/PubMed, Embase and SciELO.org databases for articles published up to 28 February 2021. In total, 38 articles and 56 patients were included. Most patients were male (66%), and the mean age was 66.63 years. Cases were predominantly associated with squamous or basal cell cancer. The most affected anatomical sites were the eyes, scalp, ears and oral cavity, and the most frequent type of larva was Crisomyia (13%). Manual removal of the larvae was considered the standard treatment, associated or not with antibiotics, analgesics and antiparasitic drugs.
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Affiliation(s)
- K K N Gonçalves
- Department of Oral and Maxillofacial Surgery, University of Pernambuco, Recife-PE, Brazil
| | - E S M de Araújo
- Faculty of Dentistry of Pernambuco, University of Pernambuco, Recife-PE, Brazil
| | - D S Barbirato
- Department of Oral and Maxillofacial Surgery, University of Pernambuco, Recife-PE, Brazil
| | - C A P do Lago
- Maxillofacial Surgery and Traumatology Service, Hospital da Restauração, Recife-PE, Brazil
| | - B C do Egito Vasconcelos
- Department of Oral and Maxillofacial Surgery, University of Pernambuco, Recife-PE, Brazil; Department of Oral and Maxillofacial Surgery, Hospital da Restauração, Pernambuco, Brazil.
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18
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Caccialanza R, Cereda E, Klersy C, Nardi M, Masi S, Crotti S, Cappello S, Caissutti V, Brovia C, Lobascio F, Formisano E, Colombo S, Filippi AR, Bonzano E, Comoli P, Catenacci L, Alberti A, Musella V, Ferrari A, Imarisio I, Tancredi R, Monaco T, Ghi MG, Bossi P, Pedrazzoli P. The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study. Ther Adv Med Oncol 2021; 13:17588359211025872. [PMID: 34527079 PMCID: PMC8436314 DOI: 10.1177/17588359211025872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, 27100, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariateresa Nardi
- Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Caissutti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlotta Brovia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Formisano
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Colombo
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Elisabetta Bonzano
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Catenacci
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Valeria Musella
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Imarisio
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Richard Tancredi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Monaco
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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19
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Tang G, Zhang L, Huang W, Wei Z. Could Immunonutrition Help in the Fight against COVID-19 in Cancer Patient? Nutr Cancer 2021; 74:1203-1212. [PMID: 34309463 DOI: 10.1080/01635581.2021.1957128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The rapid and widespread global pandemic of 2019 coronavirus disease (COVID-19) has had unprecedented negative health and economic impacts. Immune responses play a key role in the development of COVID-19, including the disruption of immune balance and cytokine storms caused by excessive inflammatory responses. Due to the effects of cancer itself and treatment, patients often accompanied by immunosuppression appear to be a susceptible population for COVID-19. Worryingly, COVID-19 with cancer is associated with a poor prognosis. Cancer patients are a vulnerable group, threatened by COVID-19, finding a way to combat COVID-19 for them is urgent. Immunonutrition is closely related to balance and strong immune function. Supplementary immunonutrition can improve the immune function and inflammatory response of cancer patients after surgery, which provides evidence for the role of immunonutrition in combating COVID-19. We reviewed possible mechanisms of immunonutrition against COVID-19, including enhancing immune cell function, increasing immune cell count, ameliorating excessive inflammatory response, and regulating gut microbiota. Immunonutrition supplementation in cancer patients may be beneficial to enhance immune function in the early stage of COVID-19 infection and control excessive inflammatory response in the late stage. Therefore, immunonutrition is a potential strategy for the prevention and treatment of COVID-19 in cancer.
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Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Zhang
- Department of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Wang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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20
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Molteni G, Comini L, Le Pera B, Bassani S, Ghirelli M, Martone A, Mattioli F, Nocini R, Santoro R, Spinelli G, Presutti L, Marchioni D, Mannelli G. Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications. J Surg Oncol 2021; 124:740-750. [PMID: 34152604 DOI: 10.1002/jso.26576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/04/2021] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.
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Affiliation(s)
- Gabriele Molteni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Lara Comini
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Beatrice Le Pera
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Sara Bassani
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Michael Ghirelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Martone
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Roberto Santoro
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Giuditta Mannelli
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Moore C, Pegues J, Narisetty V, Spankovich C, Jackson L, Jefferson GD. Enhanced Recovery After Surgery Nutrition Protocol for Major Head and Neck Cancer Surgery. OTO Open 2021; 5:2473974X211021100. [PMID: 34212121 PMCID: PMC8216366 DOI: 10.1177/2473974x211021100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To determine whether an enhanced recovery after surgery (ERAS) nutrition protocol is reasonably possible among our head and neck cancer (HNC) population with respect to system feasibility and patient compliance. Second, we aim to identify improvements in patient outcomes as a result. Methods Preexperimental research design among patients undergoing major HNC surgery after implementation of the ERAS nutrition protocol from July 2018 to July 2019 as quality improvement (QI). Preoperative clinical nutritional assessment and laboratory values were completed the same day as informed surgical consent in the clinic. Protocol focus was patient consumption of nutritional supplements perioperatively, monitored by our outpatient dietitian. Early postoperative enteral nutrition was initiated with monitoring of nutritional laboratory values. To support our model, we provide preliminary analysis of HNC patient outcomes after implementation of the ERAS nutritional protocol. Results Twenty-five patients were enrolled. Preoperatively, 40% of patients were malnourished, and 100% complied with perioperative nutrition supplementation. Health care provider compliance obtaining preoperative laboratory values was 56%. There was a strong negative correlation between modified Nutrition-Related Index (mNRI) and number of complications (P = .01), specifically, fistula rate (P = .04) and unplanned reoperation (P = .04). Enrolled patient average length of stay was 7 ± 4.4 days. Discussion Our patients demonstrated compliance with implementation of an ERAS nutrition protocol likely facilitated by dietitian engagement. mNRI potentially reflects risk for head and neck surgery complications. Implications for Practice QI processes demand reassessment and modification to ensure efficient and targeted approaches to improving patient care.
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Affiliation(s)
- Cindy Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J'undra Pegues
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Vamsi Narisetty
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Christopher Spankovich
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lana Jackson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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22
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Mitani S, Sato E, Kawaguchi N, Sawada S, Sakamoto K, Kitani T, Sanada T, Yamada H, Hato N. Case-specific three-dimensional hologram with a mixed reality technique for tumor resection in otolaryngology. Laryngoscope Investig Otolaryngol 2021; 6:432-437. [PMID: 34195364 PMCID: PMC8223462 DOI: 10.1002/lio2.581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/10/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We report our first experience of using a case-specific three-dimensional (3D) hologram for tumor resection in otolaryngology to show the proof of concept. In addition, a questionnaire was administered to assess the usefulness of the mixed reality technique in otolaryngology. METHODS A case-specific 3D hologram was developed from enhanced images of dynamic computed tomography, with reference to contrast-enhanced magnetic resonance images, and used for preoperative planning and intraoperative image reference. To evaluate the usefulness of the 3D hologram with head mount displays (HMDs), 18 attendings and resident otolaryngologists completed a questionnaire with the Likert scale. RESULTS The case-specific 3D hologram on HMDs was successfully used by means of easy gesture-handling without any monitors preoperatively and intraoperatively. The experience of picturing the tumor localization and evaluating the surgical approach was statistically better using the 3D hologram on HMDs than using the computer images (P < .01). Similarly, the holograms were observed to be better for intraoperative application and surgical education than computer images (P < .01). CONCLUSION We demonstrated the use of a case-specific 3D hologram for tumor resection in otolaryngology. The technology may be useful for preoperative planning and intraoperative image reference, especially for challenging cases, and surgical education. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Sohei Mitani
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Eriko Sato
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Naoto Kawaguchi
- Department of RadiologyEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Shun Sawada
- Department of RadiologyEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Kayo Sakamoto
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Takashi Kitani
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Tomoyoshi Sanada
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Hiroyuki Yamada
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
| | - Naohito Hato
- Department of Otolaryngology‐Head and Neck SurgeryEhime University Graduate School of MedicineShitsukawa, ToonEhimeJapan
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23
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Huber GF. Opportunities and Limits in Salvage Surgery in Persistent or Recurrent Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13102457. [PMID: 34070089 PMCID: PMC8158391 DOI: 10.3390/cancers13102457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
Except for HPV-induced cancers of the oropharynx, survival rates in patients with squamous cell carcinoma of the head and neck (HNSCC) have not changed substantially over the last decades. Salvage surgery plays an important role where primary treatment was unsuccessful since 50% of advanced-stage patients relapse after nonsurgical primary treatment. Depending on a variety of factors, a considerable number of patients in whom primary treatment was not successful can still be cured by salvage surgery. It is the goal of this review to elucidate these factors with the aim to counsel patients and their relatives realistically about the chances of being cured.
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Affiliation(s)
- Gerhard Frank Huber
- HNO-Klinik, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland; or
- Zentrum für Ohren-, Nasen-, Hals- und Plastische Gesichtschirurgie, Klinik Hirslanden, Witellikerstrasse 40, 8032 Zürich, Switzerland
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24
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The role of age in treatment decisions for oral cavity squamous cell carcinoma: Analysis of the National Cancer Database. Oral Oncol 2021; 118:105330. [PMID: 33991757 DOI: 10.1016/j.oraloncology.2021.105330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of elderly patients with oral squamous cell carcinoma (OCSCC) is increasing as the elderly population increases. Unfortunately, evidence to guide the management of these patients is lacking. METHODS Patients with OCSCC identified from the National Cancer Database (NCDB) were stratified into age-based cohorts. Demographics, comorbidities, and treatment patterns were analyzed. Patients were stratified into early stage (Stage I/II) and advanced stage (Stage III/IV) disease. The likelihood of receiving multimodality therapy by age was calculated using multinomial logistic regression for each stratum while controlling for potential confounders. Cox proportional hazard regression was used to calculate 5-year mortality risk while controlling for potential confounders. RESULTS Surgery alone or palliative options were offered to older patients more frequently. After controlling for confounders, older patients were less likely to receive multimodality therapy for both early stage and advanced stage disease. Patients with advanced disease across all age cohorts had improved 5-year survival with surgery and adjuvant therapy. CONCLUSION Our analyses suggest that elderly patients have unique demographic and pathologic features. They frequently receive less treatment than similarly staged younger patients, yet they benefit from multimodality therapy when feasible. These data suggest an urgent need to critically appraise the care of elderly OCSCC patients within the broader context of their individual comorbidity burden, functional status, and treatment goals.
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25
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Immunonutritional support as an important part of multidisciplinary anti-cancer therapy. Cent Eur J Immunol 2021; 45:454-460. [PMID: 33613095 PMCID: PMC7882412 DOI: 10.5114/ceji.2020.103339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/24/2020] [Indexed: 12/29/2022] Open
Abstract
Immunonutrition is one of the most important parts of nutritional treatment in patients with cancer. There are studies which confirm positive effects of using immunonutrition (arginine, glutamine, omega-3 fatty acids, nucleotides, pre- and probiotics) among others on the reduction of the pro-inflammatory cytokines concentrations, shortening of the hospital stay and improvement of the nutritional status. Arginine takes part not only in wound healing process, but also it improves body’s immunity and reduces the incidence of infections. Glutamine reduces the incidence of acute grade 2 and 3 esophagitis and improves quality of life of gastric cancer patients. Omega 3-fatty acids have the ability to inhibit the activity of NF-κB. They also reduce the symptoms of graft-versus-host disease in patients undergoing hematopoietic cell transplantation. Nucleotides support the regeneration of intestinal villi. Probiotics play many roles, mainly inhibit the process of carcinogenesis, reduce the incidence of diarrhea and modify intestinal microbiome. However, there are studies indicating the lack of advantages of using immunonutrition compared to standard nutrition. Currently, there is no clear evidence for the use of formulae enriched with immunonutrients versus standard oral nutritional supplements exclusively in the preoperative period. This review summarizes the current knowledge about the role of immunonutrition in supporting treatment of cancer diseases.
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Locatello LG, Mastronicola R, Cortese S, Beulque E, Salleron J, Gallo O, Dolivet G. Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma. Eur J Surg Oncol 2021; 47:1718-1726. [PMID: 33549376 DOI: 10.1016/j.ejso.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting. MATERIALS AND METHODS The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications. RESULTS With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications. CONCLUSION When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Romina Mastronicola
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
| | - Sophie Cortese
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Emilie Beulque
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gilles Dolivet
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
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Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status. Nutrients 2020; 13:nu13010057. [PMID: 33375430 PMCID: PMC7823874 DOI: 10.3390/nu13010057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.
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28
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Adiamah A, Lewis S. Is there a survival advantage of oral immunonutrition in head and neck cancer? Am J Clin Nutr 2020; 112:1427-1428. [PMID: 33184649 DOI: 10.1093/ajcn/nqaa306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alfred Adiamah
- Department of Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Stephen Lewis
- Department of Gastroenterology, Derriford Hospital, Plymouth, United Kingdom
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29
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Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial. Clin Nutr 2020; 40:1843-1850. [PMID: 33081983 PMCID: PMC7547398 DOI: 10.1016/j.clnu.2020.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
Background In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. Methods For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. Results We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. Conclusion This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. Clinical trial registration Registered under ClinicalTrials.gov Identifier no. NCT02517476.
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30
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Ramalho R, Rao M, Zhang C, Agrati C, Ippolito G, Wang FS, Zumla A, Maeurer M. Immunometabolism: new insights and lessons from antigen-directed cellular immune responses. Semin Immunopathol 2020; 42:279-313. [PMID: 32519148 PMCID: PMC7282544 DOI: 10.1007/s00281-020-00798-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
Modulation of immune responses by nutrients is an important area of study in cellular biology and clinical sciences in the context of cancer therapies and anti-pathogen-directed immune responses in health and disease. We review metabolic pathways that influence immune cell function and cellular persistence in chronic infections. We also highlight the role of nutrients in altering the tissue microenvironment with lessons from the tumor microenvironment that shapes the quality and quantity of cellular immune responses. Multiple layers of biological networks, including the nature of nutritional supplements, the genetic background, previous exposures, and gut microbiota status have impact on cellular performance and immune competence against molecularly defined targets. We discuss how immune metabolism determines the differentiation pathway of antigen-specific immune cells and how these insights can be explored to devise better strategies to strengthen anti-pathogen-directed immune responses, while curbing unwanted, non-productive inflammation.
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Affiliation(s)
- Renata Ramalho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group G.E.N.A.-IUEM), Instituto Universitário Egas Moniz, Egas Moniz Higher Education School, Monte de Caparica, Portugal
| | - Martin Rao
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Chao Zhang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | | | | | - Fu-Sheng Wang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Markus Maeurer
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal.
- I Medizinische Klinik, Johannes Gutenberg University Mainz, Mainz, Germany.
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31
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Cannady SB, Kejner AE. The Challenges of Operating on the Oldest Old-The Fountain of Youth Continues to Elude Head and Neck Reconstructive Surgeons. JAMA Otolaryngol Head Neck Surg 2019; 145:1158-1159. [PMID: 31600394 DOI: 10.1001/jamaoto.2019.2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven B Cannady
- Department of Otorhinolaryngology, Section of Head and Neck Surgery, Head and Neck Microvascular Surgery, University of Pennsylvania, Philadelphia
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