COSA comment:Head and neck cancer nutrition guidelines/Quality nutrition care - Nutrition intervention/Does nutrition intervention improve outcomes - Surgery/Does nutrition intervention improve outcomes? - Surgery

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Public comments - Does nutrition intervention improve outcomes - Surgery412:41, 6 November 2012

Public comments - Does nutrition intervention improve outcomes - Surgery

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Rhonda Cousins09:48, 11 April 2011

There is one level I positive quality paper [3], which reports on results of a systematic review on the role of immunonutrition in patients undergoing surgery for head and neck cancer. Ten randomised controlled trials (RCT’s) were included,...The pooled data showed a significant reduction in length of stay by 3.5 days, but no effect on complication rates. The trials were deemed to be small with incomplete reporting of outcomes, and the results should be interpreted with some degree of caution given that six of the ten studies were also undertaken by the same author group. The conclusions state that adequately powered trials are required to substantiate the benefit and determine the mechanism.

Does this review cover many if not all of the other studies you refer to? If so this should be the definitive answer to the question (at this stage of our knowledge as it is level 1 evidence) of whether immunonutritional support improves outcomes., 28 April 2011

Agree that the level I paper is the highest level of evidence in this area and should form the basis of our recommendations. This section has been reviewed and studies that were included in the level I paper were not repeated again.

Teresa Brown, on behalf of the authors, 17 June 2011

There is one level I positive quality paper ....

Please note the following papers and their findings on immunonutrition in gastrointestinal surgery:

Cerantola Y, Hubner M, Grass F, Demartines N and Schafer M. 2011. Immunonutriton in gastrointestinal surgery. British Journal of Surgery 98: 37–48

Drover A, Daliwhal R, Weitzel L, Wishmeyer P, 0choa J and Heyland D. 2011. Perioperative Use of Arginine-supplemented Diets: A Systematic Review of the Evidence. J Am Coll Surg (article in press)

Janie Opperman Medical and Scientific Affairs Nestle Healthcare Nutrition, United Kingdom, 13 May 2011

Thank you for bringing these to our attention. The guidelines currently have the literature review complete to January 2011. The Cerantola paper was published in January, however focuses on GI cancer only, therefore this will be excluded. The Drover paper was published in March, and so will be included in future reviews as the guidelines are systematically updated.

Teresa Brown, on behalf of the authors., 17 June 2011