1. Intraoperative Enteral Nutrition Feeding in Free‐Flap Healing after Reconstruction Surgery for Head and Neck Cancers.
- Author
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Hwang, Tzer‐Zen, Wang, Yi‐Ming, Jeng, Seng‐Feng, Lee, Yi‐Chen, Chen, Tzu‐Shan, Su, Shin‐Ying, Huang, Chien‐Chi, and Lam, Chen‐Fuh
- Abstract
Objective: To investigate the beneficial outcomes of intraoperative enteral feeding in free‐flap regeneration after extended head and neck cancer resection and flap reconstruction surgery. Study Design: A pilot randomized, double‐blind, placebo‐controlled clinical trial. Setting: Single tertiary care center. Methods: Patients with advanced head and neck cancers requiring radical tumor resections and free‐flap reconstruction were randomly assigned to receive intraoperative enteral nutrition feeding (100 kcal/100 mL at 10‐20 mL/h) via a nasogastric tube during free‐flap reconstruction (n = 28) or continue fasting (n = 28). The primary outcome was impaired free‐flap regeneration that required surgical reintervention within 90 days after the operation. Participants were enrolled between April 2020 and January 2022; the 90‐day follow‐up ended in April 2022. Results: The incidence of total or partial flap failure was similar between the 2 groups (14.2% or n = 4 in each group), but the rate of wound dehiscence or edge necrosis was significantly reduced in the feeding group (n = 6 vs 0 for fasting vs feeding; absolute risk reduction, 25.0% [95% confidence interval, 6.9‐43.0]%; p = 0.022). Hospital stay length was shorter (p = 0.042) and hand grip strength was better preserved (p = 0.025) in the feeding group. Plasma concentrations of interleukin (IL)‐6 and IL‐8 after the operation increased significantly more in the fasting group. Perioperative adverse events did not differ between the 2 groups. Conclusion: Perioperative enteral feeding is a simple, safe, and effective approach to improve perioperative systemic catabolism and proinflammatory reactions, thereby enhancing early wound regeneration after major operations. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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