A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae

Lidan Huang; Qi Zhao; Weihang Li

doi:10.5114/wiitm.2023.133439

A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae

Wideochir Inne Tech Maloinwazyjne. 2023 Dec;18(4):588-602. doi: 10.5114/wiitm.2023.133439. Epub 2023 Dec 4.

Authors

Lidan Huang¹, Qi Zhao², Weihang Li³

Affiliations

¹ Department of Anaesthesiology, Renmin Hospital of Wuhan University, Hubei Wuhan, China.
² Department of Gastrointestinal Neoplasms, The People's Hospital of Dazu Chongqing ·Dazu Hospital Affiliated with Chongqing Medical University, Chongqing, China.
³ Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Heilongjiang Harbin, China.

Abstract

Introduction: For patients with gastric cancer who have undergone gastrectomy, recent research has shown that enteral immunonutrition (EIN) is more successful than enteral nutrition (EN) at boosting host immunity and, in turn, improving prognosis. The claimed outcomes, however, are inconsistent.

Aim: This meta-analysis examines how EIN affects biochemical, immunological, and clinical outcomes for gastrectomy (GC) patients following gastrectomy and EIN formulae evidence networks.

Material and methods: A comprehensive search of the Medline, EMBASE, Scopus, and Cochrane Library databases identified English-language peer-reviewed journal papers. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. The heterogeneity was assessed using Cochrane Q and I² statistics and the appropriate p-value. The analysis used RevMan 5.3.

Results: This meta-analysis included 10 RCTs involving 1409 GC patients, 714 of whom were assigned to EIN and 695 to EN. After EIN treatment, serum proalbumin, serum transferrin, lymphocyte count, and CD4+/CD8+ ratio had statistically significant standardised mean differences (SMDs) of 2.39, 2.39, 1.34, and 0.72, respectively. EIN reduces postoperative infectious complications with an OR of 0.63 (95% CI: 0.41-0.77) for infections, an OR of 0.63 for complications, and an SMD of -1.05 for systemic inflammations. A network diagram with high-quality data and a well-defined network design with consistent and accurate connection shows that EIN can improve serum protein levels, immunological parameters, and post-operative problems.

Conclusions: The use of EIN has been shown to enhance cellular immunity, regulate inflammatory response, and decrease postoperative complications in GC patients who underwent major GI surgery.

Keywords: cellular immunity; enteral immunonutrition; enteral nutrition; gastric cancer; immune and inflammatory factors; meta-analysis; post-operative complications; post-operative infections; post-operative systemic inflammation rate; randomized controlled trials; serum proteins; total gastrectomy.