Potentially Lethal But Rarely Considered. Risk of Developing Refeeding Syndrome in Primary Oral Squamous Cell Carcinoma

Andrzej Jaxa-Kwiatkowski; Lidia Łysenko; Marta Gara-Rucińska; Anna Leszczyszyn; Hanna Gerber; Marcin Kubiak

doi:10.1016/j.jormas.2023.101742

Potentially Lethal But Rarely Considered. Risk of Developing Refeeding Syndrome in Primary Oral Squamous Cell Carcinoma

J Stomatol Oral Maxillofac Surg. 2023 Dec 22;125(5):101742. doi: 10.1016/j.jormas.2023.101742. Online ahead of print.

Authors

Andrzej Jaxa-Kwiatkowski¹, Lidia Łysenko², Marta Gara-Rucińska³, Anna Leszczyszyn⁴, Hanna Gerber¹, Marcin Kubiak¹

Affiliations

¹ Department of Maxillofacial Surgery, Medical University Wroclaw, Poland.
² Department of Anesthesiology and Intensive Therapy, Medical University Wroclaw, Poland.
³ Individual Dental Practice Walbrzych - Stomatologia Rucinscy, Poland.
⁴ Oral Surgery outpatient Clinic, 4th Military Hospital,Weigla 5 Street Wroclaw.

PMID: 38141827
DOI: 10.1016/j.jormas.2023.101742

Abstract

Presurgical preparation and postoperative care are cornerstones of all surgical procedures. Surgeons should be especially vigilant with malnourished cancer patients. Refeeding syn-drome (RFS) is a serious, potentially fatal complication of initiating appropriate nutrition in malnourished patients or after a period of starvation, although no standard precise definition has been proposed. The rarity of its une-quivocally life-threatening course means that its risk may be underestimated in clinical practice. The study's main goal was to assess the degree of malnutrition and the risk of RFS in the presurgical status of patients with oral cavity cancer and to identify risk factors for the occurrence of RFS. This single-center prospective observational study included patients diagnosed with oral squamous cell carcinoma. We investigated the relationship of RFS with age, BMI, features of the malignant tumor process selected internal medicine comorbidities, inflam-matory markers, renal and hepatic parameters, plasma levels of diverse electrolytes, and microelements were assessed. In the work, we utilized the National Institute for Health and Clinical Excellence (NICE) criteria. The study included 90 patients: 35 women and 55 men, aged 64.2±10.5. A robust statistical correlation at a significance level of p < 0.05 was demonstrated between advanced age, lower BMI, lymph node metastases, and a relatively low LDH as positive predictors of the onset of RFS and confirmed the high predictive value of the NRS-2002 scale. This paper seeks to call attention to RFS and identify critical issues that may be useful for its prevention.

Keywords: food shock; head and neck oncology; head and neck surgery; maxillofacial surgery; nutrition; refeeding syndrome.