Table_7_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（enteral immunonutrition，EIN）在胃肠道肿瘤手术患者中的应用疗效仍存在争议。本荟萃分析旨在探讨肠内免疫营养（EIN）在胃肠道肿瘤手术患者中的应用效果。方法：于2000年1月至2022年1月期间，系统检索PubMed、EMBASE、Cochrane图书馆及Web of Science数据库，筛选针对胃肠道肿瘤手术患者应用EIN对比标准饮食或无补充剂的随机对照试验（randomized controlled trials，RCTs）。本研究的主要结局指标为总体并发症及感染性并发症；次要结局指标包括非感染性并发症、死亡率、住院时长及肠内营养相关并发症。结果：最终纳入35项研究，共涉及3692例胃肠道肿瘤手术患者（包括胃癌、结直肠癌、食管癌、壶腹周围癌及胰腺癌患者）。与对照组相比，EIN组的总体并发症发生率显著降低（相对危险度（relative risk，RR）=0.79，P<0.001）。接受EIN治疗的患者其感染性并发症发生率显著低于对照组（RR=0.66，P<0.001）。针对特定感染性并发症的亚组分析显示，与对照组相比，EIN组患者的手术部位感染、腹腔脓肿、吻合口漏、菌血症发生率、全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）持续时间及抗菌药物治疗时长均显著降低；但两组在其余感染性并发症方面无显著差异。此外，EIN组患者的住院时长较对照组显著缩短；但EIN对非感染性并发症及死亡率无显著影响，且两组肠内营养相关并发症发生率无显著差异。结论：肠内免疫营养（EIN）用于胃肠道肿瘤手术患者（包括胃癌、结直肠癌、食管癌、壶腹周围癌及胰腺癌患者）时，可安全有效地降低总体并发症、感染性并发症发生率并缩短住院时长。