Table_9_Effect of Enteral Immunonutrition in Patients Undergoing Surgery for Gastrointestinal Cancer: An Updated Systematic Review and Meta-Analysis.doc

BackgroundThe efficacy of enteral immunonutrition (EIN) in patients undergoing gastrointestinal cancer surgery remains debatable. This meta-analysis aimed to investigate the effectiveness of EIN administration in patients undergoing surgery for gastrointestinal cancer.MethodsFrom January 2000 to January 2022, PubMed, EMBASE, Cochrane Library, and Web of Science were thoroughly searched for randomized controlled trials (RCTs) with EIN versus standard diet or no supplement in patients undergoing surgery for gastrointestinal cancer. Overall complications and infectious complications were the primary outcomes. The secondary results were non-infectious complications, mortality, length of hospital stay, and enteral nutrition-related complications.ResultsThirty-five studies reporting 3,692 patients undergoing surgery for gastrointestinal cancer (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer) were included. Compared with the control group, EIN group had a significantly decreased incidence of overall complications (RR = 0.79, p < 0.001). Infectious complications in patients who received EIN were considerably lower than in the control group (RR = 0.66, p < 0.001). Compared to the control group, the incidence of surgical site infection, abdominal abscess, anastomotic leakage, bacteremia, duration of systemic inflammatory response syndrome (SIRS), and duration of antibiotic therapy was significantly lower in the specific infectious complications treated with EIN. Still, there was no significant difference between the two groups with other infectious complications. Moreover, a substantial shortening in the length of hospital stay was shown in EIN group compared with the control group. Still, no significant effect of EIN was demonstrated in non-infectious complicatios and mortality. The enteral nutrition-related complications had no significant difference between two groups.ConclusionsEIN is safe and effective in reducing overall complications, infectious complications, and hospital stay in patients undergoing gastrointestinal cancer surgery (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer).

背景：肠内免疫营养（EIN）在胃肠道癌症手术患者中的疗效尚存在争议。本研究旨在调查EIN在胃肠道癌症手术患者中的施用效果。方法：自2000年1月至2022年1月，对PubMed、EMBASE、Cochrane图书馆和Web of Science进行了全面检索，以寻找关于EIN与标准饮食或无补充剂相比在胃肠道癌症手术患者中的随机对照试验（RCTs）。主要结局指标为总体并发症和感染性并发症。次要结果指标包括非感染性并发症、死亡率、住院时长以及肠内营养相关并发症。结果：纳入了35项研究，涉及3,692名进行胃肠道癌症手术（包括胃癌、结直肠癌、食管癌、胰腺癌或胆总管周围癌）的患者。与对照组相比，EIN组总体并发症的发生率显著降低（相对风险比RR = 0.79，p < 0.001）。接受EIN的患者感染性并发症的发生率显著低于对照组（RR = 0.66，p < 0.001）。与对照组相比，EIN治疗的具体感染性并发症，如手术部位感染、腹部脓肿、吻合口漏、败血症、全身炎症反应综合征（SIRS）持续时间和抗生素治疗持续时间显著降低。然而，两组在其他感染性并发症方面无显著差异。此外，EIN组与对照组相比，住院时长显著缩短。然而，在非感染性并发症和死亡率方面，EIN没有显示出显著的效果。两组在肠内营养相关并发症方面无显著差异。结论：对于胃肠道癌症手术（包括胃癌、结直肠癌、食管癌、胰腺癌或胆总管周围癌）的患者，EIN在降低总体并发症、感染性并发症和住院时长方面安全且有效。