Santos Semíramis Silva, Costa Lucianna Auxi Teixeira Josino da, Araripe Tamara Soares de Oliveira, Reges Bárbara Danuta Lins Oliveira, Ximenes Helena Maria de Albuquerque, Moreira Ana Cristina de Oliveira Monteiro
Instituto do Câncer do Ceará (ICC), RENORBIO, Universidade Estadual do Ceará (UECE), Fortaleza, Ceará, Brazil.
RENORBIO, Universidade Estadual do Ceará (UECE), Fortaleza, Ceará, Brazil.
Clin Nutr ESPEN. 2025 Aug;68:254-262. doi: 10.1016/j.clnesp.2025.05.014. Epub 2025 May 13.
Evidence shows that most gastrointestinal cancer patients develop malnutrition, which may contribute to immune function depression; inflammatory response disturbance, and stress response exacerbation, making these patients often present bad surgical results such as infections, delayed surgical wound healing, and longer hospital stays. One of the proposed nutritional strategies to combat this situation is immunonutrition, which provides nutrients that modulate the immune system activity and has been associated with better results in critically ill and surgical oncologic patients. However, the results regarding its efficiency are controversial. Thus, this article aims to evaluate the clinical, biochemical, and nutritional effects of enteral immunonutrition in patients submitted to gastrointestinal cancer surgery.
A randomized nutritional intervention study was developed in a reference hospital for oncological treatment. Gastrointestinal cancer patients undergoing surgical treatment were randomized into two groups: one receiving standard enteral nutrition and the other receiving immunomodulatory enteral nutrition. Baseline, clinical, and nutritional data were collected. Nutritional support was started immediately after surgery when clinically recommended, and its effects on clinical, biochemical, and nutritional markers were assessed.
100 patients were divided into two groups, 50 in each group. It was observed lower frequency in cases of diarrhea and post-surgical complications such as fistula and sepsis, lower gastric residue, and best parameters related to the nutritional status of iron and vitamin B12, a better immune pattern such as a higher number of lymphocytes and less than leukocytes, lower values of inflammatory acute phase proteins and significantly higher Albumin/Globulin ratio in the group receiving immunomodulatory enteral nutrition, suggesting an improvement in the profile of inflammatory markers.
Results suggest that immunomodulatory nutritional support for patients with gastrointestinal tract cancer submitted to surgery may promote a reduction in severe postoperative complications, such as fistula with sepsis and evisceration, and improve markers of immune function and renal efficiency.
有证据表明，大多数胃肠道癌症患者会出现营养不良，这可能导致免疫功能下降、炎症反应紊乱和应激反应加剧，使这些患者常常出现诸如感染、手术伤口愈合延迟和住院时间延长等不良手术结果。应对这种情况的一种营养策略是免疫营养，即提供可调节免疫系统活性的营养素，并且在重症患者和外科肿瘤患者中已显示出较好的效果。然而，关于其有效性的结果存在争议。因此，本文旨在评估肠内免疫营养对接受胃肠道癌手术患者的临床、生化和营养影响。
在一家肿瘤治疗参考医院开展了一项随机营养干预研究。接受手术治疗的胃肠道癌症患者被随机分为两组：一组接受标准肠内营养，另一组接受免疫调节肠内营养。收集基线、临床和营养数据。术后在临床建议时立即开始营养支持，并评估其对临床、生化和营养指标的影响。
100名患者分为两组，每组50人。观察到接受免疫调节肠内营养的组腹泻及瘘管和败血症等术后并发症发生率较低、胃残余量较低，与铁和维生素B12营养状况相关的指标较好，免疫模式更佳，如淋巴细胞数量增加、白细胞减少、炎症急性期蛋白值降低以及白蛋白/球蛋白比值显著升高，提示炎症标志物状况有所改善。
结果表明，对接受手术的胃肠道癌症患者进行免疫调节营养支持可能会降低严重的术后并发症，如伴有败血症的瘘管和脏器脱出，并改善免疫功能和肾功能指标。
