Nutritional Support for Hypopharyngeal Cancer Patients: Nasoduodenal Tube Feeding or Total Parenteral Nutrition, Which is Better?

Background: Morbidities such as poor wound healing and delayed recovery from illness are common in patients with poor nutritional status. Hypopharyngeal cancer patients are prone to poor nutrition, mainly due to late diagnosis and swallowing difficulties. Preoperative nutritional support is not feasible since these patients are reluctant to receive preoperative gastrostomy or jejunostomy to improve their nutritional status, mainly due to the fear of additional abdominal surgery, unless total esophageal obstruction has been encountered. Total parenteral nutrition (TPN) was routinely used in our institute for postoperative nutritional support after hypopharyngeal cancer ablation and reconstruction. Nasogastric (NG) tube feeding was abandoned due to the fear of reflux/vomiting. However, enteral nutrition should yield more superior results as compared to TPN based on published literatures. Aim and Objectives: To determine whether enteral feeding through a nasoduodenal (ND) tube can enhance better postoperative nutritional support as compared to TPN for hypopharyngeal cancer patients. Materials and Methods: From Jan 2010 to April 2011, a total of 386 head and neck reconstructions were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. A total of nineteen consecutive hypopharyngeal cancer male patients were collected, age 39~69, averaging 45.6 years old. All patients received cancer ablation and free flap reconstruction. The first nine consecutive patients (TPN group) were used as control, and received postoperative TPN; ten patients (ND group) received intraoperative endoscopic ND tube placement immediately after tumor ablation, before free flap reconstruction. Laboratory tests for albumin, prealbumin, triglyceride, and transferrin were performed preoperatively, and on postoperative day (POD) 1, 3, and 7, and absolute changes were calculated relative to preoperative levels. Changes in these laboratory parameters in TPN and ND groups were then compared using student-t tests. Results: Nineteen patients were included in the study (9 patients in the TPN group and 10 patients in the ND group). All flaps survived and the patients have recovered well. Minor infections and one hematoma were treated with secondary surgical intervention. No statistical significant changes in nutritional parameter were found between TPN and ND groups (p ＞ 0.05). Conclusion: Both the ND feeding and TPN yield comparable short-term postoperative nutritional support. However, ND can provide nutritional support at a lower cost, with acceptable intraoperative delay for its placement.