Effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy: A meta‐analysis

Abstract

We performed a meta‐analysis to evaluate the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. A systematic literature search up to November 2021 was done, and 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. They were reporting relationships about the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy using the dichotomous or contentious method with a random or fixed‐effect model. Enteral immunonutrition had no significant difference in the surgical wound infection (OR, 0.77; 95% CI, 0.50‐1.19, P = .24), the infectious complication (OR, 0.72; 95% CI, .48‐1.09, P = .13), the systemic inflammatory response syndrome (MD, ‐0.50; 95% CI, −1.40 to 0.39, P = .27), the CD8+ level (MD, 1.34; 95% CI, 0‐2.68, P = .05), the CD4+ level (MD, 1.21; 95% CI, −7.65 to 10.07, P = .79), the CD4‐CD8+ (MD, 0.55; 95% CI, 0‐1.10, P = .05), the lymphocyte (MD, −0.77; 95% CI, −1.87 to 0.33, P = .17), and the transferrin (MD, 0.03; 95% CI, −0.01 to 0.08, P = .14) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin (MD, 22.15; 95% CI, 3.57‐40.72, P = .02), IgM (MD, 0.47; 95% CI, 0.43‐0.50, P < .001), and IgG (MD, 1.98; 95% CI, 1.08‐2.89, P < .001) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Enteral immunonutrition had no significant difference in the surgical wound infection, the infectious complication, the systemic inflammatory response syndrome, the CD8+ level, the CD4+ level, the CD4+/CD8+, the lymphocyte, and the transferrin, and had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Further studies are required to validate these findings or to affect the confidence level.

Comparison of enteral immunonutrition and enteral nutrition in patients undergoing gastric cancer surgery: a systematic review and meta-analysis of randomized, controlled trials

“…This meta-analysis and systematic review included more randomized, controlled trials and showed different conclusions compared with Fu et al’s study. 26 Fu et al’s study showed that IgG, IgM, and protein concentrations in the EIN group were significantly higher from higher in the EIN group than in the EN group. Our study showed that patients in the EIN group had higher CD8+, proalbumin, and immunoglobulin concentrations, higher CD4+/CD8, and a lower incidence of postoperative infectious complications than those in the EN group.…”

“…25 and Fu et al. 26 only focused on patients with gastric cancer who underwent total gastrectomy, and some recent high-quality, randomized, controlled trials were excluded.…”

“…23 Another metaanalysis reported the pooled results of EIN use in patients with gastric cancer, 24 but the search term for EIN only used the medical subject term "enteral immunonutrition," and several articles were not included. The metaanalyses by Cheng et al 25 and Fu et al 26 only focused on patients with gastric cancer who underwent total gastrectomy, and some recent high-quality, randomized, controlled trials were excluded.…”

Harnessing interventions during the immediate perioperative period to improve the long-term survival of patients following radical gastrectomy

“…In contrast to other strategies to improve anticancer immunity, data on the beneficial effects of immunonutrients administered perioperatively are accumulating in GC[ 69 ]. Immunonutrient interventions are nutrition support that is rich in elements beneficial for the homeostasis of immunity, including ω-3-fatty acids, glutamine, arginine, and nucleotides[ 70 ].…”

Does enteral immune nutrition (EIN) boost the immunity of gastric cancer (GC) patients undergoing surgery? A systematic review and meta-analysis.

“…For example, Song et al 2015 [ 11 ], Nikniaz et al 2017 [ 12 ], and Cheng et al 2018 [ 13 ] reported in their systematic review and meta-analysis that early administration of EIN in patients was more effective in improving their immunity index and post-surgical nutritional status. Similarly, Fu et al 2021 [ 14 ] and Shen et al 2022 [ 15 ] mentioned in their systematic review and meta-analysis that pre-operative use of EIN was effective and safe in reducing the post-operative infections, overall complications of surgery, and the duration of hospital stay of patients after surgery. These systematic reviews and meta-analysis are based on the results of various randomized controlled trials, and retrospective and prospective studies that were conducted to evaluate the potential benefits of EIN in patients undergoing gastrectomy.…”