MEDICAL NUTRITION THERAPY IN 57 YEAR OLD MALE

WITH SEVERE MALNUTRITION AND POST TOTAL

LARINGECTOMY E.C. SQUAMOUS CELL CARCINOMA OF THE
LARYNX , PHARINGOCUTAN FISTULA AND TYPE II DIABETES
MELLITUS HISTORY
Yanes Natanael1, Hertanto Wahyu Subagio2
1
Peserta Program Pendidikan Dokter Spesialis Gizi Klinik FK UNDIP
2
Staf Program Pendidikan Dokter Spesialis Gizi Klinik FK UNDIP
Background
Treatment of laryngeal cancer with total laryngectomy results in changes in the anatomy
and physiology of the pharynx, causing even greater aggravation of malnutrition and a
poorer response to therapy. According to clinical nutrition guidelines, medical nutrition
therapy with adekuat nutrition is recommended to be given during postperative period
of surgery for cancer patients.

Case Report
A 57-year-old man, former driver and smoker, was diagnosed with laryngeal SCC
(T4aNxM1), with history of tracheostomy + DL biopsy 3 month earlier. The patient was
scheduled to undergo a total laryngectomy. Energy Protein Target is 35 kcal/kg/day and
1.5 gram/kg/day. 1st day after total laryngectomy diet was started at 20 kcal with
hospital-made formula and high protein via NGT, multivitamin supplementation
administered, and reached target at 2nd day with supplemental PN containing BCAAs.
One month of follow up showed stabilized body weight, improvement in HGS, food
intake dan surgical wound

Discussion
The patient is severely malnourished with ongoing inflammatory process,
hypercatabolism, and type II diabetes mellitus. Patient is given PPN with consideration
of pharingocutan fistula. Appropriate administration of macronutrients and
micronutrients help to enhance immune response and tissue regeneration.
Supplementation of vitamin A, vitamin B complex, zinc, and vitamin C play a role in
wound healing.

Conclusion
Aggressive postoperative MNT of high calorie, high protein, diabetes diet and wound
healing supplementation is associated with better outcome in post-total laryngectomy
patient due to laryngeal cancer with prior severe malnutrition.

Keyword : Laryngeal cancer with total laryngectomy, Medical Nutrition Therapy,

Diabetes Mellitus, Wound Healing

Reference
1. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN
practical guideline: Clinical nutrition in surgery. Clin Nutr [Internet]. 2021 Jul
2. Muscaritoli M, Arends J, Bachmann P, Baracos V. Barthelemy N, Bertz H, et al.
ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr [Internet]. 2021 May
3. Cogo E, Elsayed M, Liang V, Cooley K, Guerin C, Psihogios A, et al. Are
Supplemental Branched-Chain Amino Acids Beneficial During the Oncological Peri-
Operative Period: A Systematic Review and Meta-Analysis. Integr Cancer Ther
[Internet].2021 Jan
4. Sepandi M, Samadi M, Shirvani H, Alimohamadi Y, Taghdir M, Goudarzi F, et al.
Effect of whey protein supplementation on weight and body composition indicators: A
meta-analysis of randomized clinical trials. Clin Nutr ESPEN [Internet]. 2022 Aug
5. Jacobs D, Kafle S, Earles J. Rahmati R, Mehra S, Judson BL. Prolonged inpatient
stay after upfront total laryngectomy is associated with overall survival. Laryngoscope
Investig Otolaryngol [Internet]. 2021 Feb
6. Hasan Z, Dwivedi RC, Gunaratne DA, Virk SA, Palme CE, Riffat F. Systematic
review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg
Oncol EJSO (Internet]. 2017 Jan

Calori Monitoring
2000

1500

1000

500

0
H 1 H 2 H 3 H 4 H 5 H 6 H 7 H 8 H9 H10H11H12H13H14H15H16H17H18H19H20H21H22H23H24H25H26

Target Harian Target Utama Riwayat Asupan

 Protein Monitoring
90
80
70
60
50
40
30
20
10
0
H 1 H 2 H 3 H 4 H 5 H 6 H 7 H 8 H 9 H10H11H12H13H14H15H16H17H18H19H20H21H22H23H24H25H26

Target Harian Target Utama Riwayat Asupan

Body Weight Monitoring

60
55 55 55 55
50
40
30
20
10
0
H1 H7 H14 H28

Series 1

Hari ke 2
Hari ke 33