| Background Gastric cancer(GC)is one of the most common gastrointestinal cancer,and its morbidity and mortality are among the highest in the world.The main treatment of gastic cancer is surgery.The recovery of gastric cancer patients after operation is affected by many factors,such as physical fitness,nutritional status,surgical trauma stress and so on.Malnutrition is more common in gastric cancer.Studies shows that the incidence of postoperative complications and mortality is significantly increased of gastric cancer patients with malnutrition,which is extremely adverse to the whole treatment process.Therefore,nutritional support plays an important role in clinical.At present,Enteral nutrition is one of the current nutritional support methods.It can not only supply the energy needed by the body,but also has a comprehensive composition,which is more in line with physiology.And it plays an positive role in protecting the maintain intestinal mucosal barrier function,prevent enteric bacterial translocation and maintaining the stability of the internal environment.Therefore,enteral nutrition is the main nutritional support in the in perioperative period of gastrointestinal cancer.Numerous studies have shown that preoperative enteral nutrition can significantly improve the postoperative nutritional status and immune function,alleviate inflammatory response,prevent postoperative complications and facilitate the recovery of patients.However,some scholars have different conclusions that preoperative enteral nutrition has no advantage in the prevention of postoperative complications,and even that give rise to some adverse reactions.Therefore,it is still controversial whether preoperative enteral nutrition is beneficial to postoperative patients with gastic cancer.In this study,evidence-based medicine will be used to systematically evaluate the preoperative enteral nutrition on the short-term postoperative effect in patients with gastric cancer.Objective To systematically review the short-term effects of preoperative enteral nutrition supplementation on the nutritional status,immune function,inflammatory response,the recovery of intestinal function and complications of gastric cancer patients.Thus to provide evidence for promoting postoperative recovery of gastric cancer patients.Methods The Pubmed,Cochrane library,Embase,Web of Science,CNKI,VIP,Wan Fang databases were searched from the building of databases to September 2019,for randomized controlled trials of preoperative enteral nutritionin in patients undergoing surgery for gastric cancer.The quality evaluation and bias risk analysis of the included literatures were carried out.The data of each indicator analysis was performed using Rev Man v5.3 software.Sensitivity analysis and publication bias evaluation were conducted.Results A total of 1652 literatures were retrieved.16 randomized controlled trials(12 in Chinese,4 in English)were included after screening.Both the experimental group and the control group had 775 patients,with a total of 1550 patients.A meta-analysis of11 indicators in 5 groups showed that: nutritive indicators: 11 studies compared the postoperative albumin(MD=1.94,95%CI[1.47~2.42],P<0.00001);9 studies compared the postoperative prealbumin(MD=1.94,95%CI[1.47~2.42],P<0.00001).Immune indicators: 6 studies compared postoperative cellular immune indicators,CD4+T cell subsets(MD=2.54,95%CI[1.43~3.66],P<0.00001);CD8+T cell subsets(MD=-2.50,95%CI[-3.45~-1.56],P<0.00001);CD4+/CD8+(MD=0.26,95%CI[0.03~0.49],P=0.03);The indicators of postoperative humoral immunity: 8 studies compared the indicat ors of postoperative Ig G and Ig A,Ig G(MD=0.32,95%CI[0.11~0.54],P=0.003);Ig A(MD=0.03,95%[CI-0.24~0.29],P=0.85);4 studies compared the indicators of postoperative Ig M(MD=0.14,95%CI[-0.10~0.39],P=0.24).4 studies compared the indicators of postoperative inflammatory response: CRP(MD=-0.22,95%CI[-0.29~-0.15],P<0.00001).6 studies compared the time of postoperative first exhaust time(MD=-17.25,95%CI[-34.81~0.32],P=0.05).8 studies compared postoperative complications(OR=0.59,95%CI[0.40~0.87],P=0.008).The result of sensitivity analysis of the included literatures was stable.There was no obvious publication bias in the included literatures.Conclusion The preoperative enteral nutrition can enhance the short-term nutritional status and immune ability of postoperative patients at risk of malnutrition with gastric cancer,which reduce the postoperative stress response and complications.But have no significant effect on the postoperative recovery of intestinal function. |
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