The perioperative care of patients with head and neck cancer is complex and requires significant preoperative planning and patient education. The issues include analgesia, antibiotics, stoma and wound care, general and chest physiotherapy, thromboprophylaxis and nutrition. This article provides a clear way to anticipate and manage the variety of problems that can arise. The recommendation is to adopt an MDT approach with clear discussion with the patient and their family about the nature of the perioperative and postoperative period. Key points include the need to formally assess risk of malnutrition by gauging the extent of weight loss (>5% in past month or >10% in past six months) together with the Patient-Generated Subjective Global Assessment tool. There is a useful discussion of risk / benefits of preoperative carbohydrate loading, timing of postoperative nutrition and supportive nutrition which may include immune-enhancing nutrition supplementation with arginine, omega 3 and RNA. Importantly the authors advocate for nasogastric tube rather than gastrostomy tube placement where possible and necessary, unless in high risk patients. The rest of the article describes useful strategies for antimicrobial prophylaxis, preventing venous thromboembolism and multimodal analgesia regimes. As there is a growing acknowledgement that ‘failure-to-rescue’ has detrimental effects and appropriate perioperative care can mitigate the incidence of such events, this is a helpful article that I would recommend all otolaryngologists read.

Nutrition and perioperative care for the patient with head and neck cancer.
Gill A, Farwell DG, Moore MG.
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Deepak Chandrasekharan

UCL, London, UK.

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