Enteral combined with parenteral nutrition and enteral nutrition alone in postoperative patients with gastric cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Xingxia ¹ , HU Yanjie ^1,2 ,  LI Ka ^1,2

1. West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. West China School of Nursing, Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

LI Ka, Email: lika127@126.com

Keywords：

Gastric cancer; Nutritional support; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202107190

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of enteral nutrition combined with parenteral nutrition (EN+PN) and enteral nutrition alone (EN) in gastric cancer patients undergoing gastrectomy. Methods PubMed, EMbase, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of EN+PN and EN in gastric cancer patients undergoing gastrectomy from inception to September 25^th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 23 RCTs were included. The results of meta-analysis showed that compared to EN group, EN+PN group had a shorter hospital stay (MD=?1.75, 95%CI ?2.45 to ?1.05, P<0.000 1) and a lower risk of postoperative complications (RR=0.55, 95%CI 0.46 to 0.66, P<0.000 1). However, there was no statistical difference in the first exhaust time between the two groups. Conclusion The current evidence shows that EN+PN may contribute to reducing the incidence of postoperative complications and shortening the length of hospital stay in gastric cancer patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.

Citation： ZHANG Xingxia, HU Yanjie, LI Ka. Enteral combined with parenteral nutrition and enteral nutrition alone in postoperative patients with gastric cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(1): 60-66. doi: 10.7507/1672-2531.202107190 Copy

1.	International Agency for Research on Cancer. Latest global cancer data: Cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. Available at: https://www.iarc.who.int/pressrelease/latest-global-cancer-data-cancer-burden-rises-to-19-3-million-new-cases-and-10-0-million-cancer-deaths-in-2020/.
2.	Yang D, Zheng Z, Zhao Y, et al. Patient-generated subjective global assessment versus nutritional risk screening 2002 for gastric cancer in Chinese patients. Future Oncol, 2020, 16(3): 4475-4483.
3.	Guo ZQ, Yu JM, Li W, et al. Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life. Support Care Cancer, 2020, 28(1): 373-380.
4.	Li J, Xu R, Hu DM, et al. Prognostic nutritional index predicts outcomes of patients after gastrectomy for cancer: a systematic review and meta-analysis of nonrandomized studies. Nutr Cancer, 2019, 71(4): 557-568.
5.	Jiang N, Deng JY, Ding XW, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol, 2014, 20(30): 10537-10544.
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31.	劉存貞, 李相梅, 王少彥, 等. 老年胃癌術后早期腸內, 外營養的聯合應用. 實用臨床醫學, 2009, 10(7): 19-21.
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1. International Agency for Research on Cancer. Latest global cancer data: Cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. Available at: https://www.iarc.who.int/pressrelease/latest-global-cancer-data-cancer-burden-rises-to-19-3-million-new-cases-and-10-0-million-cancer-deaths-in-2020/.
2. Yang D, Zheng Z, Zhao Y, et al. Patient-generated subjective global assessment versus nutritional risk screening 2002 for gastric cancer in Chinese patients. Future Oncol, 2020, 16(3): 4475-4483.
3. Guo ZQ, Yu JM, Li W, et al. Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life. Support Care Cancer, 2020, 28(1): 373-380.
4. Li J, Xu R, Hu DM, et al. Prognostic nutritional index predicts outcomes of patients after gastrectomy for cancer: a systematic review and meta-analysis of nonrandomized studies. Nutr Cancer, 2019, 71(4): 557-568.
5. Jiang N, Deng JY, Ding XW, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol, 2014, 20(30): 10537-10544.
6. 張捷. 術后早期腸外聯合腸內營養對老年進展期胃癌患者早期預后效果分析. 上海: 上海交通大學, 2015.
7. 吳國豪, 毛翔宇. 成人圍手術期營養支持指南. 中華外科雜志, 2016, 54(9): 641-657.
8. Nagata S, Fukuzawa K, Iwashita Y, et al. Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study. Nutr J, 2009, 8: 24.
9. 陳振. 神經重癥早期聯合營養與單純腸內營養的比較研究. 南京: 南京醫科大學, 2019.
10. 王艷娜, 全海英, 黃靖涓. 補充性腸外營養用于危重癥患者營養支持效果的Meta分析. 現代臨床護理, 2019, 18(12): 36-41.
11. 姚培宇, 丁釙, 張茁. 腸內外聯合營養對機械通氣患者預后影響的Meta分析. 繼續醫學教育, 2017, 31(1): 139-141.
12. Knobloch K, Yoon U, Vogt PM. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. J Craniomaxillofac Surg, 2011, 39(2): 91-92.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 (updated March 2011). The Cochrane Collaboration, 2011. Available at: www. cochrane-handbook. org.
14. Barili F, Parolari A, Kappetein PA, et al. Statistical primer: heterogeneity, random- or fixed-effects model analyses. Interact Cardiovasc Thorac Surg, 2018, 27(3): 317-321.
15. Lin L, Chu H. Quantifying publication bias in meta-analysis. Biometrics, 2018, 74(3): 785-794.
16. 朱凌云, 杭凌, 王衛理. 老年胃癌患者術后腸內腸外營養支持的研究. 當代醫學, 2009, 15(34): 7-8.
17. 周憲, 樊春波, 胡長江, 等. 早期腸內及腸外營養支持對老年胃癌術后的運用分析. 現代生物醫學進展, 2015, 15(19): 3668-3670, 3677.
18. 周典偉, 余剛. 早期免疫強化腸內-腸外聯合營養對老年進展期胃癌患者術后恢復的影響. 中國老年學雜志, 2020, 40(5): 955-959.
19. 周典偉, 余剛. 進展期胃癌患者腹腔鏡根治術后早期聯合應用腸內和腸外營養的效果觀察. 世界最新醫學信息文摘, 2019, 19(67): 1-2.
20. 趙瀅, 王強. 三種營養支持方法在胃癌術后的應用. 山東醫藥, 2008, 48(37): 90-92.
21. 趙曉雷, 彭俊生. 不同營養支持方法在胃癌病人術后的應用. 腸外與腸內營養, 2007, 14(1): 32-34, 38.
22. 楊衛民, 張敬成, 梁偉, 等. 老年胃癌患者術后腸內腸外營養支持的評估. 中華胃腸外科雜志, 2004, 7(4): 305-307.
23. 楊蘭, 張霞. 胃癌術后早期腸外聯合腸內營養支持治療的臨床效果. 西部醫學, 2017, 29(11): 1555-1559.
24. 薛振峰, 徐鈞. 胃癌術后不同營養支持方式治療的療效對比. 中國醫藥科學, 2015, (5): 21-23, 26.
25. 吳利明. 三種營養支持方法在胃癌術后的臨床應用分析. 中國醫藥指南, 2012, 10(21): 565-566.
26. 吳國珍, 高勝強, 毛根軍, 等. 不同營養方式在腹腔鏡遠端胃癌根治術后的臨床療效. 世界華人消化雜志, 2020, 28(18): 898-903.
27. 王駿揚, 林喆. 胃癌根治術后腸外營養與早期腸內營養的聯合應用. 消化腫瘤雜志(電子版), 2013, 5(3): 176-179.
28. 孫江華. 胃癌術后腸內腸外營養聯合應用分析. 醫藥論壇雜志, 2013, 34(2): 46-47, 50.
29. 劉昭暉, 蘇國強, 張思宇, 等. 老年胃癌術后早期營養支持方式臨床研究. 中華胃腸外科雜志, 2013, 16(11): 1063-1066.
30. 劉妮. 不同營養支持方式對進展期胃癌術后病人臨床結局的影響. 青島: 青島大學, 2004.
31. 劉存貞, 李相梅, 王少彥, 等. 老年胃癌術后早期腸內, 外營養的聯合應用. 實用臨床醫學, 2009, 10(7): 19-21.
32. 梁偉, 達春麗, 陶應龍, 等. 術后不同營養支持途徑對老年胃腸腫瘤病人臨床療效的影響. 臨床外科雜志, 2017, 25(9): 708-711.
33. 李煒, 李旭, 張曉燕, 等. 高齡胃癌患者術后營養支持的臨床研究. 現代護理, 2007, 13(28): 2666-2668.
34. 黃進林, 嚴偉華, 伍志輝. 胃癌術后早期腸內外混合營養的應用分析. 中外醫學研究, 2013, 11(36): 42-43.
35. 胡飛, 俞林沖, 戴海強. 芻議不同營養支持方法在胃癌患者術后的應用效果. 中國實用醫藥, 2016, 11(36): 81-83.
36. 陳格亮, 張靜, 花超, 等. 胃癌術后早期腸內, 腸外營養治療的臨床研究. 現代消化及介入診療, 2019, 24(4): 411-415.
37. Huang D, Sun Z, Huang J, et al. Early enteral nutrition in combination with parenteral nutrition in elderly patients after surgery due to gastrointestinal cancer. Int J Clin Exp Med, 2015, 8(8): 13937-13945.
38. 饒敏. 胃癌根治術后腸內外營養聯合應用臨床療效分析. 中國現代藥物應用, 2013, 7(22): 73-74.
39. Finnerty CC, Mabvuure NT, Ali A, et al. The surgically induced stress response. JPEN J Parenter Enteral Nutr, 2013, 37(5 Suppl): 21S-29S.
40. Desborough JP. The stress response to trauma and surgery. Br J Anaesth, 2000, 85(1): 109-117.
41. Tang F, Tie Y, Tu C, et al. Surgical trauma-induced immunosuppression in cancer: Recent advances and the potential therapies. Clin Transl Med, 2020, 10(1): 199-223.
42. Aoyama T. Perioperative body composition changes in the multimodal treatment of gastrointestinal cancer. Surg Today, 2020, 50(3): 217-222.
43. Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J, 2013, 54(6): 1370-1376.
44. Zhang X, Chen X, Yang J, et al. Effects of nutritional support on the clinical outcomes of well-nourished patients with cancer: a meta-analysis. Eur J Clin Nutr, 2020, 74(10): 1389-1400.
45. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
46. Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
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Chinese Journal of Evidence-Based Medicine

Enteral combined with parenteral nutrition and enteral nutrition alone in postoperative patients with gastric cancer: a meta-analysis

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