Abstract
PurposeImmunonutrition has been used to prevent the complications after colorectal elective surgery. This systematic review aimed to analyze and assess the effect of immunonutrition on colorectal cancer patients who received elective surgery.MethodsThree electronic databases (Medline, Embase, Cochrane) were used to search the latent studies which investigated the effects of enteral immunonutrition (EIN) compared with standard enteral nutrition (EN) or parenteral immunonutrition (PIN) compared with standard parenteral nutrition (PN) on colorectal cancer patients who are undergoing surgery until 21st of April, 2017. Meta-analysis was conducted to calculate odd risk (OR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI), and heterogeneity was tested by Q test.ResultsNine publications were included. The meta-analysis results presented that EIN improved the length of hospital stay (pooled MD, 2.53; 95% CI, 1.29–3.41), infectious complications (pooled OR, 0.33; 95% CI, 0.21–0.53) which contains the Surgical Site Infections (pooled OR, 0.25; 95% CI, 0.22–0.58) and Superficial/Deep incisional infections (pooled OR, 0.27; 95% CI, 0.12–0.64); meanwhile, PIN improved the length of hospital stay (pooled MD, 2.66; 95% CI, 0.62–4.76), IL-6 (pooled MD, − 6.09; 95% CI, − 10.11 to − 2.07), CD3 (pooled MD, 7.50; 95% CI, 3.57–11.43), CD4 (pooled MD, 5.47; 95% CI, 2.54–8.40), and CD4/CD8 (pooled MD, 0.50; 95% CI, 0.22–0.78); the level of CD8 was lower (pooled MD, − 4.32; 95% CI, − 7.09 to − 1.55) in PIN.ConclusionImmunonutrition could be an effective approach to enhance the immune function of colorectal cancer patients undergoing elective surgery and to improve the clinical and laboratory outcomes.
Highlights
IntroductionOmega-3 fatty acid could reduce the platelet-adhesive endothelial interactions and the synthesis of proinflammatory eicosanoids, while it could stimulate the produce of glutathione which can decrease oxidative injury [4,5,6]
Colorectal cancer is one of the most commonly diagnosed cancers in the world [1]
Laboratory indicators including biochemical indices and immune indices (e.g., T cell subsets, cytokines, and immunoglobulin) were measured both before and after the surgery in EN/EIN; in PN/PIN, they were measured 1 day and 1 week after the surgery, respectively; the clinical outcomes including length of hospital stay (LOS), readmission, and complications were measured within 30 days after surgery
Summary
Omega-3 fatty acid could reduce the platelet-adhesive endothelial interactions and the synthesis of proinflammatory eicosanoids, while it could stimulate the produce of glutathione which can decrease oxidative injury [4,5,6]. Int J Colorectal Dis (2018) 33:273–283 element of innate antimicrobial immunity in the host’s first line of defense [7]. It plays an important role in maintaining the physiological balance of gastrointestinal tract [8] and regulating the metabolism of many kinds of lymphocyte [9]. As the major fuel source for macrophages, lymphocytes, and enterocytes, could increase the level of gut mucosal glutathione, thereby reduce free radical availability, and decrease inflammation [10, 11]. Deficiency of glutamine may lead to impaired immune function and dysfunction of intestinal epithelium [15]
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