title: Role of Enteral Immunonutrition in Patients Undergoing Surgery for Gastric Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: Gastric cancer (GC) is one of the most common upper gastrointestinal malignancies. Surgical resection remains the mainstay of curative treatment for GC. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve inflammatory response of patients undergoing surgery for GC; however, conclusions across studies still remain unclear. We aimed to evaluate the effects of EIN for such patients.We searched some electronic databases including PubMed, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE to identify any latent studies which investigated the effects of EIN compared with standard EN on GC patients who undergoing surgery until the end of December 30, 2014. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were calculated and we also assessed heterogeneity by using Cochrane Q and I statistic combined with corresponding P-value.We included 9 eligible studies which included 785 patients eventually. The meta-analysis results shown that EIN increased level of IgA (MD, 0.31; 95% CI, 0.12-0.51), IgG (MD, 1.5; 95% CI, 0.73-2.28), IgM (MD, 0.22; 95% CI, 0.06-0.39), CD4 (SMD, 0.81; 95% CI, 0.53-1.09), CD3 (SMD, 0.68; 95% CI, 0.21-1.15), CD4/CD8 ratio (MD, 0.56; 95% CI, 0.12-1.01), and NK cell (MD, 2.35; 95% CI, 0.66-4.05); decreased IL-6 (MD, -98.22; 95% CI, -156.16 to -40.28) and TNF-α (MD, -118.29; 95% CI, -162.00 to -74.58), but not improve remained outcomes of interest involving postoperative complications, length of hospitalization, serum total protein, and CD8. Descriptive analysis suggested that EIN also increased the concentration of IL-2 but not CRP. Impact on lymphocytes remains inconsistent.EIN is effective for enhancing host immunity and relieving the inflammatory response in GC patients undergoing gastrectomy, but clinical outcomes cannot be benefit from it. Heterogeneity caused by different compositions and timing of administration of EIN regimes and not enough sample size and number of eligible studies in most of sensitive analyses with subgroup analysis may impaired the power of our study, and thus some large-scale and well-designed studies are warranted to further establish effects.
authors.affiliation: From the Department of Nursing, Tianjin Hospital, Tianjin, People's Republic of China (G-MS); Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China (XT, L-JY, ZZ, TS, LZ); School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China (HL); Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China (J-GZ); College of TCM, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China (Y-XO); and School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China (XT, L-JY, ZZ, TS, YW).
authors.forename: Guo-Min
authors.initials: GM
authors.lastname: Song
authors.forename: Xu
authors.initials: X
authors.lastname: Tian
authors.forename: Hui
authors.initials: H
authors.lastname: Liang
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Yi
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhou
authors.forename: Zi
authors.initials: Z
authors.lastname: Zeng
authors.forename: Ting
authors.initials: T
authors.lastname: Shuai
authors.forename: Yang-Xiang
authors.initials: YX
authors.lastname: Ou
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D004750:Enteral Nutrition; D006801:Humans; D007167:Immunotherapy; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery*