Prognostic value of serum 25-hydroxyvitamin D levels and malnutrition status on postoperative complications in patients following laryngectomy with neck dissection

Nemanja Radivojevic; Sandra Sipetic Grujicic; Vesna Suljagic; Stefan Stojkovic; Konstantin Arsovic; Sasa Jakovljevic; Bojana Bukurov; Nenad Arsovic

doi:10.1007/s00405-024-09046-5

Prognostic value of serum 25-hydroxyvitamin D levels and malnutrition status on postoperative complications in patients following laryngectomy with neck dissection

Eur Arch Otorhinolaryngol. 2024 Oct 22. doi: 10.1007/s00405-024-09046-5. Online ahead of print.

Authors

Nemanja Radivojevic¹, Sandra Sipetic Grujicic², Vesna Suljagic³, Stefan Stojkovic⁴, Konstantin Arsovic⁵, Sasa Jakovljevic⁶, Bojana Bukurov⁶, Nenad Arsovic⁶

Affiliations

¹ Faculty of Medicine, University of Belgrade, Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia. nemanjardv@gmail.com.
² Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ Medical Faculty, Military Medical Academy, Department of Healthcare-Related Infection Control, University of Defense, Military Medical Academy, Belgrade, Serbia.
⁴ Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia.
⁵ Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
⁶ Faculty of Medicine, University of Belgrade, Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.

PMID: 39438295
DOI: 10.1007/s00405-024-09046-5

Abstract

Background: Postoperative complications (PCs) following total laryngectomy remain a significant challenge, with recent investigations directed toward the impact of nutrition status and vitamin D deficiency.

Objectives: To elucidate the association between preoperative vitamin D level status, malnutrition risk score, and surgical and survival outcomes in patients with advanced laryngeal cancer following total laryngectomy.

Study design: Prospective cohort study.

Methods: Sixty-four patients with advanced laryngeal carcinoma treated with total laryngectomy were included in the study. Serum levels of 25(OH) D₃ were measured employing a commercial chemiluminescent immunoassay kit, while nutrition status was evaluated using the nutrition risk index (NRI) and Malnutrition universal screening tool (MUST).

Results: The mean serum 25(OH) D level was 37.1 ± 19.4 nmol/L (range 11.0-100.6 nmol/L), with 47% of patients exhibiting vitamin D deficiency and 31% displaying insufficiency. Medium/high MUST score had 53% of patients, and moderate/severe NRI was verified in 48% of patients. Univariate logistic regression analysis identified MUST score, GPS score, neutrophil-to-lymphocyte ratio, and circulating 25(OH) D levels as predictive for the occurrence of PCs. In multivariate analysis, MUST score and circulating 25(OH) D levels remained significantly associated with PCs. Patients with high nutrition risk had significantly lower two-year OS rates compared to the medium and low nutrition risk groups, respectively (30% vs. 62% and 83%, p = 0.010).

Conclusion: Early identification of malnourished or patients with vitamin D deficiency and those who would benefit from specific nutritional support could be beneficial for minimizing the risk of development of surgical complications and help improve our clinical outcomes.

Keywords: Laryngeal cancer; Malnutrition; Postoperative complications; Total laryngectomy; Vitamin D deficiency.