Effect of perioperative immunonutrition on outcomes in gastric cancer surgery patients: A systematic review and evidence map

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-10 DOI:10.1016/j.clnesp.2025.02.029

Chen Xin , Yanqiu Wang , Yuhong Luo , Yubiao Gai , Binru Han

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引用次数: 0

Abstract

Background

Tumors and surgical procedures trigger a series of metabolic responses that put gastric cancer patients at constant risk of malnutrition during the perioperative period. Meanwhile, the effectiveness of enteral immunonutrition (EIN) for these patients remains a subject of ongoing debate.

Objective

This systematic review and evidence map aim to retrieve randomized controlled trials (RCTs) on perioperative EIN interventions in gastric cancer patients undergoing surgery and evaluate their effectiveness.

Methods

A systematic search strategy was established using the Population, Intervention, Comparison, Outcomes and Study design (PICOS) framework to identify relevant RCTs evaluating EIN for gastric cancer surgery patients. The databases searched were PubMed, Web of Science, Embase, CINAHL, and CENTRAL (Cochrane Library), covering studies published up to September 30, 2024. Two reviewers independently screened titles and abstracts. The quality of the studies was assessed using the Cochrane Risk of Bias Tool version 2 (RoB 2). Data were independently extracted and descriptively synthesized, with the results summarized in an evidence gap map.

Results

In this systematic review, 20 studies that met the inclusion criteria were included, focusing on the effects of perioperative EIN on patients with gastric cancer. The interventions involved various immunonutrients such as arginine, omega-3 fatty acids, glutamine, and ribonucleic acid, with different initiation times ranging from preoperative to postoperative, and durations ranging from 5 to 28 days. Most studies used EN as the control, while some used PN. The risk of bias assessment revealed that three studies had a high risk of bias, primarily due to issues with randomization. The majority of studies focused on changes in immune function and inflammatory markers, with some also evaluating postoperative infection complications or other clinical outcomes. The evidence gap map (EGM) analysis showed that although postoperative interventions were more common, only 45.45 % of these studies demonstrated a “positive impact”, while the remaining studies indicated a “possible positive impact” or “no effect”. Overall, EIN interventions showed some positive effects on immune function and inflammatory markers, but results varied across studies.

Conclusions

This review summarized the effects of perioperative EIN in gastric cancer surgery patients, highlighted existing gaps and suggested future research to optimize its application.

查看原文本刊更多论文

围手术期免疫营养对胃癌手术患者预后的影响：系统回顾和证据图谱。

背景：肿瘤和手术过程引发一系列代谢反应，使胃癌患者在围手术期处于持续的营养不良风险中。同时，肠内免疫营养（EIN）对这些患者的有效性仍然是一个持续争论的主题。目的：本系统综述和证据图旨在检索随机对照试验（rct）对胃癌手术患者围手术期EIN干预的影响，并评价其有效性。方法：采用人群、干预、比较、结果和研究（PICOS）框架建立系统检索策略，筛选评估胃癌手术患者EIN的相关rct。检索的数据库为PubMed、Web of Science、Embase、CINAHL和CENTRAL (Cochrane Library)，涵盖截至2024年9月30日发表的研究。两位审稿人独立筛选标题和摘要。使用Cochrane风险偏倚工具第2版（RoB 2）评估研究的质量。数据独立提取和描述性合成，结果汇总在证据缺口图中。结果：本系统综述纳入20项符合纳入标准的研究，重点关注围手术期EIN对胃癌患者的影响。干预涉及各种免疫营养素，如精氨酸、欧米伽-3脂肪酸、谷氨酰胺和核糖核酸，起始时间从术前到术后不同，持续时间从5天到28天不等。大多数研究使用EN作为对照，也有一些研究使用PN作为对照。偏倚风险评估显示，三个研究具有高偏倚风险，主要是由于随机化的问题。大多数研究集中在免疫功能和炎症标志物的变化上，也有一些研究评估术后感染并发症或其他临床结果。证据缺口图（EGM）分析显示，虽然术后干预更为常见，但只有45.45%的研究显示有“积极影响”，其余研究显示“可能有积极影响”或“无影响”。总体而言，EIN干预对免疫功能和炎症标志物有一定的积极作用，但研究结果各不相同。结论：本文综述了围手术期EIN在胃癌手术患者中的作用，指出了存在的不足，并提出了进一步的研究建议，以优化其应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.