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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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.
6.	张捷. 术后早期肠外联合肠内营养对老年进展期胃癌患者早期预后效果分析. 上海: 上海交通大学, 2015.
7.	吴国豪, 毛翔宇. 成人围手术期营养支持指南. 中华外科杂志, 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.	陈振. 神经重症早期联合营养与单纯肠内营养的比较研究. 南京: 南京医科大学, 2019.
10.	王艳娜, 全海英, 黄靖涓. 补充性肠外营养用于危重症患者营养支持效果的Meta分析. 现代临床护理, 2019, 18(12): 36-41.
11.	姚培宇, 丁钋, 张茁. 肠内外联合营养对机械通气患者预后影响的Meta分析. 继续医学教育, 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.
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16.	朱凌云, 杭凌, 王卫理. 老年胃癌患者术后肠内肠外营养支持的研究. 当代医学, 2009, 15(34): 7-8.
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21.	赵晓雷, 彭俊生. 不同营养支持方法在胃癌病人术后的应用. 肠外与肠内营养, 2007, 14(1): 32-34, 38.
22.	杨卫民, 张敬成, 梁伟, 等. 老年胃癌患者术后肠内肠外营养支持的评估. 中华胃肠外科杂志, 2004, 7(4): 305-307.
23.	杨兰, 张霞. 胃癌术后早期肠外联合肠内营养支持治疗的临床效果. 西部医学, 2017, 29(11): 1555-1559.
24.	薛振峰, 徐钧. 胃癌术后不同营养支持方式治疗的疗效对比. 中国医药科学, 2015, (5): 21-23, 26.
25.	吴利明. 三种营养支持方法在胃癌术后的临床应用分析. 中国医药指南, 2012, 10(21): 565-566.
26.	吴国珍, 高胜强, 毛根军, 等. 不同营养方式在腹腔镜远端胃癌根治术后的临床疗效. 世界华人消化杂志, 2020, 28(18): 898-903.
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28.	孙江华. 胃癌术后肠内肠外营养联合应用分析. 医药论坛杂志, 2013, 34(2): 46-47, 50.
29.	刘昭晖, 苏国强, 张思宇, 等. 老年胃癌术后早期营养支持方式临床研究. 中华胃肠外科杂志, 2013, 16(11): 1063-1066.
30.	刘妮. 不同营养支持方式对进展期胃癌术后病人临床结局的影响. 青岛: 青岛大学, 2004.
31.	刘存贞, 李相梅, 王少彦, 等. 老年胃癌术后早期肠内, 外营养的联合应用. 实用临床医学, 2009, 10(7): 19-21.
32.	梁伟, 达春丽, 陶应龙, 等. 术后不同营养支持途径对老年胃肠肿瘤病人临床疗效的影响. 临床外科杂志, 2017, 25(9): 708-711.
33.	李炜, 李旭, 张晓燕, 等. 高龄胃癌患者术后营养支持的临床研究. 现代护理, 2007, 13(28): 2666-2668.
34.	黄进林, 严伟华, 伍志辉. 胃癌术后早期肠内外混合营养的应用分析. 中外医学研究, 2013, 11(36): 42-43.
35.	胡飞, 俞林冲, 戴海强. 刍议不同营养支持方法在胃癌患者术后的应用效果. 中国实用医药, 2016, 11(36): 81-83.
36.	陈格亮, 张静, 花超, 等. 胃癌术后早期肠内, 肠外营养治疗的临床研究. 现代消化及介入诊疗, 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.	饶敏. 胃癌根治术后肠内外营养联合应用临床疗效分析. 中国现代药物应用, 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.
47.	Nikniaz Z, Somi MH, Nagashi S, et al. Impact of early enteral nutrition on nutritional and immunological outcomes of gastric cancer patients undergoing gastrostomy: a systematic review and meta-analysis. Nutr Cancer, 2017, 69(5): 693-701.
48.	Rosania R, Chiapponi C, Malfertheiner P, et al. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors, 2016, 2(4): 178-187.
49.	Li B, Liu HY, Guo SH, et al. Impact of early enteral and parenteral nutrition on prealbumin and high-sensitivity C-reactive protein after gastric surgery. Genet Mol Res, 2015, 14(2): 7130-7135.
50.	Cai J, Yang G, Tao Y, et al. A meta-analysis of the effect of early enteral nutrition versus total parenteral nutrition on patients after pancreaticoduodenectomy. HPB (Oxford), 2020, 22(1): 20-25.
51.	Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database. Crit Care Med, 2021, 49(1): 49-59.
52.	周飞燕, 许勤, 陈丽, 等. 胃癌术后患者早期肠内营养达标状况及其影响因素研究. 护理学杂志, 2012, 27(6): 76-78.
53.	翁延宏, 顾国胜, 朱永龙, 等. 胃癌病人术后早期肠内营养不耐受的风险因素及对预后影响. 肠外与肠内营养, 2017, 24(3): 155-158,163.
54.	谢薄, 吴莉莉. 热敏灸对胃癌病人根治术后早期肠内营养耐受性的影响. 肠外与肠内营养, 2019, 26(2): 83-86.
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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. 张捷. 术后早期肠外联合肠内营养对老年进展期胃癌患者早期预后效果分析. 上海: 上海交通大学, 2015.
7. 吴国豪, 毛翔宇. 成人围手术期营养支持指南. 中华外科杂志, 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. 陈振. 神经重症早期联合营养与单纯肠内营养的比较研究. 南京: 南京医科大学, 2019.
10. 王艳娜, 全海英, 黄靖涓. 补充性肠外营养用于危重症患者营养支持效果的Meta分析. 现代临床护理, 2019, 18(12): 36-41.
11. 姚培宇, 丁钋, 张茁. 肠内外联合营养对机械通气患者预后影响的Meta分析. 继续医学教育, 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, 王卫理. 老年胃癌患者术后肠内肠外营养支持的研究. 当代医学, 2009, 15(34): 7-8.
17. 周宪, 樊春波, 胡长江, 等. 早期肠内及肠外营养支持对老年胃癌术后的运用分析. 现代生物医学进展, 2015, 15(19): 3668-3670, 3677.
18. 周典伟, 余刚. 早期免疫强化肠内-肠外联合营养对老年进展期胃癌患者术后恢复的影响. 中国老年学杂志, 2020, 40(5): 955-959.
19. 周典伟, 余刚. 进展期胃癌患者腹腔镜根治术后早期联合应用肠内和肠外营养的效果观察. 世界最新医学信息文摘, 2019, 19(67): 1-2.
20. 赵滢, 王强. 三种营养支持方法在胃癌术后的应用. 山东医药, 2008, 48(37): 90-92.
21. 赵晓雷, 彭俊生. 不同营养支持方法在胃癌病人术后的应用. 肠外与肠内营养, 2007, 14(1): 32-34, 38.
22. 杨卫民, 张敬成, 梁伟, 等. 老年胃癌患者术后肠内肠外营养支持的评估. 中华胃肠外科杂志, 2004, 7(4): 305-307.
23. 杨兰, 张霞. 胃癌术后早期肠外联合肠内营养支持治疗的临床效果. 西部医学, 2017, 29(11): 1555-1559.
24. 薛振峰, 徐钧. 胃癌术后不同营养支持方式治疗的疗效对比. 中国医药科学, 2015, (5): 21-23, 26.
25. 吴利明. 三种营养支持方法在胃癌术后的临床应用分析. 中国医药指南, 2012, 10(21): 565-566.
26. 吴国珍, 高胜强, 毛根军, 等. 不同营养方式在腹腔镜远端胃癌根治术后的临床疗效. 世界华人消化杂志, 2020, 28(18): 898-903.
27. 王骏扬, 林喆. 胃癌根治术后肠外营养与早期肠内营养的联合应用. 消化肿瘤杂志(电子版), 2013, 5(3): 176-179.
28. 孙江华. 胃癌术后肠内肠外营养联合应用分析. 医药论坛杂志, 2013, 34(2): 46-47, 50.
29. 刘昭晖, 苏国强, 张思宇, 等. 老年胃癌术后早期营养支持方式临床研究. 中华胃肠外科杂志, 2013, 16(11): 1063-1066.
30. 刘妮. 不同营养支持方式对进展期胃癌术后病人临床结局的影响. 青岛: 青岛大学, 2004.
31. 刘存贞, 李相梅, 王少彦, 等. 老年胃癌术后早期肠内, 外营养的联合应用. 实用临床医学, 2009, 10(7): 19-21.
32. 梁伟, 达春丽, 陶应龙, 等. 术后不同营养支持途径对老年胃肠肿瘤病人临床疗效的影响. 临床外科杂志, 2017, 25(9): 708-711.
33. 李炜, 李旭, 张晓燕, 等. 高龄胃癌患者术后营养支持的临床研究. 现代护理, 2007, 13(28): 2666-2668.
34. 黄进林, 严伟华, 伍志辉. 胃癌术后早期肠内外混合营养的应用分析. 中外医学研究, 2013, 11(36): 42-43.
35. 胡飞, 俞林冲, 戴海强. 刍议不同营养支持方法在胃癌患者术后的应用效果. 中国实用医药, 2016, 11(36): 81-83.
36. 陈格亮, 张静, 花超, 等. 胃癌术后早期肠内, 肠外营养治疗的临床研究. 现代消化及介入诊疗, 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. 饶敏. 胃癌根治术后肠内外营养联合应用临床疗效分析. 中国现代药物应用, 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.
47. Nikniaz Z, Somi MH, Nagashi S, et al. Impact of early enteral nutrition on nutritional and immunological outcomes of gastric cancer patients undergoing gastrostomy: a systematic review and meta-analysis. Nutr Cancer, 2017, 69(5): 693-701.
48. Rosania R, Chiapponi C, Malfertheiner P, et al. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors, 2016, 2(4): 178-187.
49. Li B, Liu HY, Guo SH, et al. Impact of early enteral and parenteral nutrition on prealbumin and high-sensitivity C-reactive protein after gastric surgery. Genet Mol Res, 2015, 14(2): 7130-7135.
50. Cai J, Yang G, Tao Y, et al. A meta-analysis of the effect of early enteral nutrition versus total parenteral nutrition on patients after pancreaticoduodenectomy. HPB (Oxford), 2020, 22(1): 20-25.
51. Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database. Crit Care Med, 2021, 49(1): 49-59.
52. 周飞燕, 许勤, 陈丽, 等. 胃癌术后患者早期肠内营养达标状况及其影响因素研究. 护理学杂志, 2012, 27(6): 76-78.
53. 翁延宏, 顾国胜, 朱永龙, 等. 胃癌病人术后早期肠内营养不耐受的风险因素及对预后影响. 肠外与肠内营养, 2017, 24(3): 155-158,163.
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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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