Intraoperative Enteral Nutrition Feeding in Free‐Flap Healing after Reconstruction Surgery for Head and Neck Cancers

Abstract

AbstractObjectiveTo investigate the beneficial outcomes of intraoperative enteral feeding in free‐flap regeneration after extended head and neck cancer resection and flap reconstruction surgery.Study DesignA pilot randomized, double‐blind, placebo‐controlled clinical trial.SettingSingle tertiary care center.MethodsPatients 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.ResultsThe 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.ConclusionPerioperative 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.