Development and initial clinical application of an early enteral nutrition protocol in oral cancer patients undergoing flap reconstruction surgery

This study developed an evidence-based early enteral nutrition (EEN) protocol for flap-reconstructed oral cancer patients using the Nutrition Care Process Model, refined through Delphi consultation (9 experts, 100% response rate, authority coefficient = 0.912). The finalized protocol contains 5 first-level, 15 second-level, and 31 third-level items. This prospective longitudinal study employed consecutive sampling to enroll 35 oral cancer patients undergoing flap reconstruction at a Grade-A tertiary hospital in Shandong Province (December 2023-May 2024). Venous blood samples were collected at preoperative baseline (T0), 24 h postoperatively (T1), and postoperative day 7 (T2) to evaluate nutritional parameters (serum total protein, albumin, hemoglobin) and inflammatory biomarkers (leukocyte count, absolute neutrophils). Repeated-measures ANOVA revealed significant decreases in patients' nutritional indices at T1 compared to baseline levels (all P < 0.05), followed by significant recovery at T2 relative to T1 measurements (P < 0.05). Conversely, inflammatory markers exhibited significant elevation at T1 (P < 0.05), with subsequent reduction at T2 (P < 0.05). Notably, although T2 inflammatory levels demonstrated significant decline compared to T1, they remained elevated relative to baseline (T0) values (P < 0.05). The incidence of postoperative complications in patients was 8.57%, with a mean hospital stay of (10.11 ± 2.41) days. This study was registered at MedicalResearch.org.cn. Trial No. MR-37-23-024753. Retrospective registered 2023.