Short-term evaluation of immune levels and nutritional values of EN versus PN in gastric cancer: a systematic review and a meta-analysis

Abstract

Background Postsurgical patients’ oral feeding begins with clear fluids 1–3 days after surgery. This might not be sufficiently nutritious to boost the host immune system and provide sufficient energy in gastric neoplastic patients to achieve the goal of enhanced recovery after surgery (ERAS). Our objective was to analyze the significance of early postoperative feeding tubes in boosting patients’ immunity and decreasing incidence of overall complications and hospital stay in gastric cancer patients’ post-gastrectomy. Methods From January 2005 to May 24, 2019, PubMed and Cochrane databases were searched for studies involving enteral nutrition (EN) feeding tubes in comparison to parenteral nutrition (PN) in gastric cancer patients undergoing gastrectomy for gastric malignancies. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were used to estimate the effect sizes, and heterogeneity was assessed by using Q and χ 2 statistic with their corresponding P values. All the analyses were performed with Review Manager 5.3 and SPSS version 22. Results Nine randomized trials ( n = 1437) and 5 retrospective studies ( n = 421) comparing EN feeding tubes and PN were deemed eligible for the pooled analyses, with a categorized time frame of PODs ≥ 7 and PODs < 7. Ratio of CD4+/CD8+ in EN feeding tubes was the only outcome of PODs < 7, which showed significance (MD 0.22, 95% CI 0.18–0.25, P < 0.00001). Regarding other immune indicators, significant outcomes in favor of EN feeding tubes were measured on POD ≥ 7: CD3+ (SMD 1.71; 95% CI 0.70, 2.72; P = 0.0009), CD4+ (MD 5.84; 95% CI 4.19, 7.50; P < 0.00001), CD4+/CD8+ (MD 0.28; 95% CI 0.20; 0.36, P < 0.00001), NK cells (SMD 0.94; 95% CI 0.54, 1.30; P < 0.00001), nutrition values, albumin (SMD 0.63; 95% CI 0.34, 0.91; P < 0.001), prealbumin (SMD 1.00; 95% CI 0.52, 1.48; P < 0.00001), and overall complications (risk ratio 0.73 M-H; fixed; 95% CI 0.58, 0.92; P = 0.006). Conclusion EN feeding tube support is an essential intervention to elevate patients’ immunity, depress levels of inflammation, and reduce the risk of complications after gastrectomy for gastric cancer. Enteral nutrition improves the innate immune system and nutrition levels but has no marked significance on certain clinical outcomes. Also, EN reduces the duration of hospital stay and cost, significantly.

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

“…It also currently remains unclear whether preoperative immunonutrition reduces morbidity rates after gastrectomy for GC [ 44 – 46 ]. Xin et al [ 47 ] has recently shown by a systematic review and a meta-analysis that enteral nutrition feeding tube support is an essential intervention to elevate patients’ immunity, depress levels of inflammation, and reduce the risk of complications after gastrectomy for GC. Therefore, further research and the development of novel treatment methods that fundamentally suppress cancer-induced inflammation and boost host immunity are desired.…”

Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis

“…Gastric malignancy is one of the established malignancies associated with high incidence of mortality worldwide. Recent articles have reported the modern diagnostic and treatment methods on eradication of Helicobacter pylori to have a direct link on the decline in gastric cancer [ 1 – 3 ]. Gastric cancer rates have dwindled in diagnosis across the world but lamentably, it remains to be a conundrum in the surgical field [ 4 , 5 ].…”

Integrated analysis of 1804 samples of six centers to construct and validate a robust immune-related prognostic signature associated with stromal cell abundance in tumor microenvironment for gastric cancer

“…Surgical resection, radiotherapy, and chemotherapy are still the main treatment methods, but the effect is not ideal [ 12 ]. In recent years, experts in the field of GC research have pointed out that parameters reflecting individual immune status, such as preoperative systemic immune-inflammation index (SII) [ 30 ], Follistatin-like 1 (FSTL1) [ 31 ], immune T cell subsets (including CD3+, CD4+, CD8+, CD4+/CD8+ ratio, NK Cells) [ 32 ], the preoperative and the postoperative neutrophil-to-lymphocyte ratios (NLR) [ 33 – 36 ], and platelet-lymphocyte ratio (PLR) [ 37 ], may be useful prognostic indicators of GC. Previously studies have shown that immune-related genes can effectively predict the prognosis of patients with colonic adenocarcinoma [ 38 ], but the relationship between immune-related genes and the prognosis of GC has not been fully clarified.…”