Abstract
ObjectivesOptimal enteral immunonutrition (EIN) regime for gastric cancer (GC) patients underwent gastrectomy remains uncertainty. To assess comparative efficacy of different EIN formulas in GC patients underwent gastrectomy, we performed network meta-analysis.ResultsWe included 11 RCTs enrolling 840 patients. Pairwise meta-analysis indicated that EIN (RR 0.56, 95% CI 0.36-0.86; MD -0.42, 95% CI -0.74—0.10), Arg+RNA+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75—0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22—1.07) reduced ICs and LOS. Network meta-analysis confirmed the potential of Arg+RNA+ω-3-FAs for ICs (OR 0.27, 95% Crl 0.12–0.49) and Arg+Gln+ω-3-FAs for CIs (OR 0.22, 95% Crl 0.02–0.84) and LOS (SMD -0.63, 95% Crl -1.07—0.13), and indicated that Arg+RNA+ω-3-FAs was superior to Arg+RNA and Arg+Gln for ICs as well.Materials and MethodsWe performed direct and network meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition (SEN) in reducing infectious complications (ICs), noninfectious complications (NICs) and length of hospital stay (LOS), through January 2016. The surface under the cumulative ranking curve (SCURA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to rank regimes and rate qualities of evidences respectively.ConclusionsAs for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS.
Highlights
Gastric cancer (GC) is the one of the most common digestive tract cancers, which is the fifth most common type of cancer and the third most cause of cancer-death [1]
Pairwise meta-analysis indicated that enteral immunonutrition (EIN) (RR 0.56, 95% confidence intervals (CIs) 0.36-0.86; mean difference (MD) -0.42, 95% CI -0.74—0.10), Arg+ribonucleic acid (RNA)+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75—0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22—1.07) reduced infectious complications (ICs) and length of hospital stay (LOS)
As for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS
Summary
Gastric cancer (GC) is the one of the most common digestive tract cancers, which is the fifth most common type of cancer and the third most cause of cancer-death [1]. In purpose of improving the immune function, relieving the inflammation response, and decreasing the postoperative complications of the GC patients underwent gastrectomy, as well as shortening the length of hospital stay (LOS) eventually, enteral immunonutrition (EIN) which is supplemented with at least 2 of arginine (Arg), glutamine (Gln), omega-3 fatty acids (ω-3-FAs), and www.impactjournals.com/oncotarget ribonucleic acid (RNA) has been extensively investigated in clinical practice [4, 7, 8]. The EIN support regime includes various formulas, such as the combination of SEN, Arg and RNA and the combination of SEN, Arg and Gln. Hitherto, no trial has been planned to investigate the comparative efficacy of different EIN formulas. No trial has been planned to investigate the comparative efficacy of different EIN formulas As a result, it is unclear which EIN formulas are the optimal nutrition support regimes for GC patients underwent gastrectomy
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