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Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients: a randomized clinical trial.
Wang, WK, Tu, CY, Shao, CX, Chen, W, Zhou, QY, Zhu, JD, Xu, HT
Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas. 2019;(5):e8265
Abstract
We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients, controls). Clinical, economic, and laboratory indices were analyzed. ERAS patients showed faster recovery and shorter postoperative hospital stays than the controls (P<0.05). Some clinical indices (i.e., time to first flatus and defecation, time to removal of drainage tubes, time to resumption of oral feeding, time to postoperative mobilization, and postoperative complications) were significantly better in ERAS patients than in controls. Duration of postoperative infusion was lower in ERAS patients than in controls (P<0.05). In ERAS patients, serum albumin and prealbumin were higher on postoperative day 7, C-reactive protein was lower on postoperative days 3 and 7, and neutrophil count was lower on postoperative day 3 compared to the values in controls (P<0.05 for all). IgM levels were higher in ERAS patients on postoperative days 3 and 7 (P<0.05), while IgG levels were higher on postoperative day 3 (P<0.05). Total T lymphocytes were higher in ERAS patients on postoperative day 3, while helper T cells and CD4+/CD8+ ratio were higher on postoperative days 3 and 7 (P<0.05 for all). In gastric carcinoma patients, ERAS may reduce perioperative inflammation, improve immunity and postoperative nutrition, shorten hospitalization, and enhance rehabilitation.
2.
The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis.
Wong, CS, Aly, EH
International journal of surgery (London, England). 2016;:137-50
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Abstract
AIM: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery. METHODS Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models. RESULTS Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. The ratio of patients underwent oesophagectomy:gastrectomy:pancreatectomy was 2.2:1.2:1.0. IEN, when administered post-operatively, was associated with a significantly lower risk of wound infection (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.40 to 0.88; p = 0.009) and shorter length of hospital stay (MD -2.92 days, 95% CI -3.89 to -1.95; p < 0.00001). No significant differences in other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality between the two groups were identified. CONCLUSIONS Overall, our analysis found that IEN decreases wound infection rates and reduces length of stay. It should be recommended as routine nutritional support as part of the Enhanced Recovery after Surgery (ERAS) programmes for upper GI Surgery.
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Enteral immunonutrition versus standard enteral nutrition for patients undergoing oesophagogastric resection for cancer.
Mabvuure, NT, Roman, A, Khan, OA
International journal of surgery (London, England). 2013;(2):122-7
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Abstract
A best evidence topic in surgery was written according to a structured protocol. The question addressed was "In cancer patients undergoing oesophageal or gastric resection for cancer and requiring postoperative nutritional support, does enteral immunonutrition confer additional clinical benefits as compared to standard enteral nutrition? Two hundred and fifty-eight papers were identified by a search of the MEDLINE and EMBASE databases, of which six randomized controlled trials represented the best evidence to answer this clinical question. The authors, journal, date and country of publication, patient group, study group, relevant outcomes and results of these papers were tabulated. All six of these randomised controlled trials compared the clinical benefits of standard enteral nutrition with those of enteral nutrition supplemented with a variety of immune-modulating substances. The studies failed to demonstrate consistent differences in patients' postoperative clinical course, complications, length of hospital stay and inflammatory marker levels. Hence although there is reasonable evidence to suggest that immunonutrition improves humoral immunity as opposed to cellular immunity, this improvement does not result in reductions in infection rates or reduced hospital stay. There is currently not enough evidence to recommend routine immunonutrition in all patients undergoing oesophageal or gastric resection for cancer.