Effect of preoperative enteral immunonutrition on clinical efficacy and safety of postoperative patients with colorectal cancer:a Meta-analysis and GRADE evaluation
LI Xiaoqian
GUAN Hua
XU Xiaotao
DING Linfei
Abstract：Objective:To systematically evaluate the effect of preoperative enteral immunonutrition on patients with colorectal cancer,in order to provide reference for clinical nutritional treatment.Methods:RCTs of preoperative enteral immunonutrition in patients with colorectal cancer were retrieved from PubMed,Web of Science,EMbase,CBM,CNKI,WanFang Database,VIP.The search deadline was from database establishment to April 7,2023.According to the inclusion and exclusion criteria,two reviewers screened the literature,extracted data,and evaluated the quality.RevMan 5.4 software was used for Meta-analysis.Results:A total of 16 articles were included,involving 1 462 patients.The Meta-analysis results showed that there was no statistically significant difference(P＞0.05)in CD8+levels and the incidence of non infectious complications between the two groups.Compared with the control group,the experimental group can increase the levels of IgA(MD=0.47,95％CI 0.16-0.79,P=0.003),IgG(MD=2.03,95％CI 1.34-2.71,P＜0.000 1),IgM(MD=0.24,95％CI 0.09-0.39,P=0.001),CD4+(MD=2.81,95％CI 2.19-3.44,P＜0.000 1),CD4+/CD8+(MD=0.15,95％CI 0.10-0.20,P＜0.000 01),hemoglobin(MD=9.11,95％CI 0.74-17.49,P=0.03),serum albumin(MD=2.27,95％CI 0.92-3.61,P=0.001),and prealbumin(MD=52.35,95％CI 15.21-89.50,P=0.006),which can reduce the overall incidence of infectious complications(RR=0.46,95％CI 0.28-0.73,P=0.001),incision infections(RR=0.60,95％CI 0.40-0.89,P=0.01),and lung infections(RR=0.38,95％CI 0.16-0.88,P=0.02).The results of GRADE systematic review showed that the quality of evidence level of IgG,CD4+/CD8+,total infection complication rate,incision infection rate,lung infection rate,and total non-infection complication rate were medium;IgA,IgM,CD4+,CD8+,serum albumin were low;and hemoglobin and prealbumin were very low.Conclusion:The existing evidence shows that preoperative enteral immunonutrition can effectively improve the humoral and cellular immune functions,improve the nutritional status and reduce the incidence of infectious complications in patients with colorectal cancer after surgery.
Keywords：immunonutritionenteral nutritioncolorectal cancerMeta-analysisevidence-based nursing
Publication Date：2024-01-31
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：11( 191-201 )