Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy.
OBJECTIVE
To determine whether immune-enhanced enteral nutrition (EN) was effective on nutritional status, immune function, surgical outcomes and days of hospitalization after total gastrectomy for patients with advanced gastric cancer (AGC).


METHODS
From August 2005 to May 2011, 78 patients with AGC who underwent a total gastrectomy were enrolled and divided randomly into three groups: immune-enhanced EN (EN + glutamine [Gln]) group, standard EN group and control group. Serum parameters including total protein, albumin, proalbumin and transferrin were examined on preoperative day 1, postoperative day 2 and day 12. Levels of immunoglobulin M (IgM), immunoglobulin G (IgG), natural killer (NK) cells, CD4⁺ and CD8⁺ T cells were also compared.


RESULTS
The formulas were tolerated well in all the patients except 5 with mild complications. The EN + Gln and EN groups showed a faster onset of flatus and shorter hospitalization duration than the control group. On postoperative day 12, serum total protein, albumin, proalbumin and transferrin levels of the EN + Gln and EN groups were significantly higher than those of the control group (P < 0.05). CD4⁺ T cells, NK cells, IgM and IgG levels of the EN + Gln group increased prominently, and were significantly higher than those before the operation as well as those in the EN and control groups.


CONCLUSIONS
Immune-enhanced EN can improve nutritional status and immune function for the patients with AGC after total gastrectomy.
Department of General Surgery, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Hua
H
Liu
Wei
W
Ling
Zhi Yong
ZY
Shen
Xin
X
Jin
Hui
H
Cao
D000418:Albumins; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated; D005743:Gastrectomy; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007694:Killer Cells, Natural; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011182:Postoperative Care / Q000379:methods; D011228:Prealbumin / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism; D013274:Stomach Neoplasms / Q000097:blood / Q000276:immunology / Q000628:therapy*; D014168:Transferrin / Q000378:metabolism
D000418:Albumins; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D011228:Prealbumin; D012709:Serum Albumin; D014168:Transferrin; D005973:Glutamine