Surgical correction of nutritional status as an element of an integrated approach in the treatment and rehabilitation of patients with malignant tumors of the head and neck organs

Introduction. A significant proportion of patients with malignant neoplasms of the head and neck have protein and energy deficiency, which is associated with the localization of the tumor in close proximity to the proximal digestive tract, its aggressive growth, the presence of complications of the tumor process, as well as drug and / or radiation treatment. If there is a violation of the full replenishment of the need for nutrients in a natural way, the need for longterm nutritional support at the stages of antitumor treatment and the preservation of the function of the gastrointestinal tract, the method of choice is the formation of a gastrostomy. In addition to the effects of its direct purpose, gastrostomy promotes social adaptation of patients, as well as eliminates the risks associated with the installation and prolonged use of a nasogastric tube, and is compatible with other surgical procedures at the stages of antitumor treatment, symptomatic and palliative care.

Aim. To evaluate the clinical and social significance of performing gastrostomy in patients with squamous cell carcinoma of the head and neck.

Materials and methods. The present study included 150 patients with squamous cell carcinoma of the head and neck organs who underwent minimally invasive gastrostomy (133 / 150; 88.7 %), open-label (11 / 150; 7.3 %) or interventional under CT control (6 / 150; 4 %). In 88 (58.7 %) patients, gastrostomy was combined with other medical procedures (tumor biopsy, tracheostomy, selective intraarterial embolization). Descriptive statistics methods and the t-test were used to evaluate the results of the study. The differences were considered significant at p <0.05.

Results. Postoperative complications were observed in 12.7 % of patients, hospital mortality was 2 %. The average length of stay of patients in the hospital with uncomplicated course of the postoperative period was 7.1 ± 5.0 days, in the presence of complications – 18.2 ± 18.5 days. Among patients receiving antitumor treatment after gastrostomy drainage, the median time between gastrostomy and its onset was 20 days, and the median overall survival was 261.5 days. for patients under medical supervision, the median overall survival reached 621 days. This indicator in patients who did not receive antitumor treatment after gastrostomy and patients referred to the palliative Care Center was 52 and 61 days, respectively.

Conclusion. performing gastrostomy in a minimally invasive manner is an essential component of the prehabilitation of debilitated patients with complicated squamous cell carcinoma of the head and neck organs. This manipulation allows you to start or resume antitumor treatment, as well as increase overall survival.