Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus: A systematic review and meta-analysis.

Abstract

This study aimed to synthesise available data and evaluate the clinical evidence regarding the effect of early enteral nutrition versus total parenteral nutrition on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. This systematic review and meta-analysis was designed, conducted and reported following the PRISMA guideline. We performed searches in PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure and Wanfang Database. The study designs were randomised controlled trials, quasi-randomised controlled trials, and controlled clinical trials. The trials compared early enteral nutrition (experimental group) with total parenteral nutrition (control group) in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. The risk of bias was assessed using the Cochrane risk of bias tool. A total of 19 trials (1255 patients) were included. Meta-analysis showed a significantly shorter length of hospital stay (days; mean difference-5.07, 95% confidence interval [CI] [-6.28, -3.86], p < 0.00001) and a lower post-operative complications rate (%; odds ratio0.29, 95% CI [0.16, 0.50], p < 0.0001) in the early enteral nutrition group than in the total parenteral nutrition group. Compared with the total parenteral nutrition group, the early enteral nutrition group had lower blood glucose fluctuation values (mmol/L; mean difference-2.03, 95% CI [-2.44, -1.61], p < 0.00001), lower levels of glycosylated haemoglobin (%; mean difference -0.62, 95% CI [-1.22, -0.03], p=0.04), higher levels of prealbumin (g/L; p=0.002), transferrin (g/L; p=0.002), total protein (g/L; p=0.001) and haemoglobin (g/L; p=0.005). Early enteral nutrition may maintain stable blood glucose levels and improve nutritional status, leading to better therapeutic effectiveness in gastric cancer complicated with diabetes mellitus patients.