Effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy: A meta‐analysis

• Published in: International wound journal Vol. 19; no. 7; pp. 1625 - 1636
• Main Authors: Fu, Houfeng, Li, Bing, Liang, Zhenxiong
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2022; John Wiley & Sons, Inc
• Subjects: Bias; Blood Proteins; cellular immunity; Clinical trials; Digestive system; enteral immunonutrition; Enteral Nutrition; Fatty acids; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric cancer; Gastrointestinal cancer; Gastrointestinal surgery; Hospitals; Humans; immune and inflammatory factors; Immunity (Disease); Immunity, Cellular; Immunoglobulin G; Immunoglobulin M; Length of stay; Malnutrition; Meta-analysis; Metabolism; Nutrition; Original; Parenteral nutrition; Postoperative Complications - etiology; Prealbumin; Proteins; Statistical analysis; Stomach Neoplasms - complications; Stomach Neoplasms - surgery; Surgical site infections; Surgical Wound Infection - surgery; Systemic Inflammatory Response Syndrome - complications; Systemic Inflammatory Response Syndrome - surgery; Transferrins; enteral nutrition; immune and inflammatory factors; gastric cancer; enteral immunonutrition; cellular immunity
• ISSN: 1742-4801; 1742-481X; 1742-481X
• DOI: 10.1111/iwj.13763

We performed a meta‐analysis to evaluate the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. A systematic literature search up to November 2021 was done, and 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. They were reporting relationships about the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy using the dichotomous or contentious method with a random or fixed‐effect model. Enteral immunonutrition had no significant difference in the surgical wound infection (OR, 0.77; 95% CI, 0.50‐1.19, P = .24), the infectious complication (OR, 0.72; 95% CI, .48‐1.09, P = .13), the systemic inflammatory response syndrome (MD, ‐0.50; 95% CI, −1.40 to 0.39, P = .27), the CD8+ level (MD, 1.34; 95% CI, 0‐2.68, P = .05), the CD4+ level (MD, 1.21; 95% CI, −7.65 to 10.07, P = .79), the CD4‐CD8+ (MD, 0.55; 95% CI, 0‐1.10, P = .05), the lymphocyte (MD, −0.77; 95% CI, −1.87 to 0.33, P = .17), and the transferrin (MD, 0.03; 95% CI, −0.01 to 0.08, P = .14) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin (MD, 22.15; 95% CI, 3.57‐40.72, P = .02), IgM (MD, 0.47; 95% CI, 0.43‐0.50, P < .001), and IgG (MD, 1.98; 95% CI, 1.08‐2.89, P < .001) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Enteral immunonutrition had no significant difference in the surgical wound infection, the infectious complication, the systemic inflammatory response syndrome, the CD8+ level, the CD4+ level, the CD4+/CD8+, the lymphocyte, and the transferrin, and had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Further studies are required to validate these findings or to affect the confidence level.