Xin Chen, Wang Yanqiu, Luo Yuhong, Gai Yubiao, Han Binru
Xuanwu Hospital, Capital Medical University, Beijing, China; School of Nursing, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
Clin Nutr ESPEN. 2025 Jun;67:90-104. doi: 10.1016/j.clnesp.2025.02.029. Epub 2025 Mar 10.
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.
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.
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.
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.
This review summarized the effects of perioperative EIN in gastric cancer surgery patients, highlighted existing gaps and suggested future research to optimize its application.
肿瘤和外科手术会引发一系列代谢反应，使胃癌患者在围手术期持续面临营养不良的风险。与此同时，肠内免疫营养（EIN）对这些患者的有效性仍是一个持续争论的话题。
本系统评价和证据图谱旨在检索关于接受手术的胃癌患者围手术期EIN干预的随机对照试验（RCT），并评估其有效性。
使用人群、干预措施、对照、结局和研究设计（PICOS）框架建立系统检索策略，以识别评估EIN对胃癌手术患者疗效的相关RCT。检索的数据库包括PubMed、Web of Science、Embase、CINAHL和CENTRAL（Cochrane图书馆），涵盖截至2024年9月30日发表的研究。两名 reviewers 独立筛选标题和摘要。使用Cochrane偏倚风险工具第2版（RoB 2）评估研究质量。数据被独立提取并进行描述性综合，结果汇总在证据缺口图中。
在本系统评价中，纳入了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。干预措施涉及多种免疫营养素，如精氨酸、ω-3脂肪酸、谷氨酰胺和核糖核酸，起始时间从术前到术后各不相同，持续时间从5天到28天不等。大多数研究使用肠内营养（EN）作为对照，而一些研究使用肠外营养（PN）。偏倚风险评估显示，三项研究存在高偏倚风险，主要是由于随机化问题。大多数研究关注免疫功能和炎症标志物的变化，一些研究还评估了术后感染并发症或其他临床结局。证据缺口图（EGM）分析表明，虽然术后干预更为常见，但这些研究中只有45.45%显示出“积极影响”，其余研究表明“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显示出一些积极影响，但研究结果各不相同。
本综述总结了围手术期EIN对胃癌手术患者的影响，突出了现有差距，并建议未来进行研究以优化其应用。
