Early Enteral Nutrition or Not?:

Meta-Analysis of Efficacy of Sijunzi Decoction Combined with Enteral Nutrition for the Treatment of Gastric Cancer

Objective: Whether to conduct Sijunzi decoction combined with enteral nutrition (SJZD/EN) in patients with gastric cancer (GC) remains controversial. This study was aimed to systematically analyze the efficacy and safety of SJZD/EN in patients with gastric cancer.Methods: We performed searches in PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang database, and Chinese Biomedicine Literature Database (SinoMed) to identify relevant literature comparing SJZD/EN with conventional EN for GC patients. The analysis was carried out with RevMan 5.3.Results: A total of 10 randomized controlled trials (688 patients) were included. Meta-analysis showed a significantly shorter time to flatus (t/h) (MD, -9.45; 95% CI, -10.76 to -8.13; p < 0.00001), a shorter length of hospital stay (t/d) (MD, -5.22; 95% CI, -7.46 to -2.99; p < 0.00001), and a lower incidence of postoperative complications (%) (OR, 0.14; 95% CI, 0.03-0.64; p = 0.01) in the SJZD/EN group than the EN group. Compared with the EN, the SJZD/EN group had a higher level of albumin(g/L) (MD, 2.59; 95% CI, 1.90-3.28; p <  0.00001), prealbumin (mg/L) (MD, 36.81; 95% CI, 13.41-60.20; p = 0.002), transferrin (g/L) (MD, 0.19; 95% CI, 0.10-0.28; p < 0.0001), immunoglobulin G (g/L) (MD, 2.61; 95% CI, 2.12-3.09; p < 0.00001), immunoglobulin A (g/L) (MD, 0.38; 95% CI, 0.31-0.45, p < 0.00001), immunoglobulin M (g/L) (MD, 0.31; 95% CI, 0.22-0.41; p < 0.00001), CD3⁺ (%) (MD, 6.73; 95% CI, 3.48-9.98; p < 0.0001), CD4⁺ (%) (MD, 4.32; 95% CI, 3.30-5.33; p < 0.00001), and CD4⁺/CD8⁺ (MD, 0.20; 95% CI, 0.11-0.28; p < 0.00001).Conclusions: Sijunzi decoction combined with enteral nutrition appears to have efficacy and safety for gastric cancer.

Meta-analysis of preoperative oral nutritional supplements for patients with gastric cancer: East Asian experience

Whether it is beneficial to give preoperative oral nutritional supplements (P-ONS) to gastric cancer (GC) patients is still inconclusive. This study aimed to systematically explore the effectiveness and safety of P-ONS in GC patients. The PubMed, EMBASE, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were searched to identify relevant literature. A total of 11 randomized controlled trials (1183 patients) were included. Meta-analysis showed significantly lower levels of white blood cells (MD, -0.65; 95% CI, -1.01 to -0.30; P = 0.0003) and C-reactive protein (MD, -0.24; 95% CI, -0.31 to -0.16; P < 0.00001) in the P-ONS group than those in the routine diet group. Compared with the routine diet group, the P-ONS group had higher levels of albumin (MD, 1.63; 95% CI, 0.40-2.87; P = 0.010), IgG (MD, 0.65; 95% CI, 0.44-0.86; P < 0.00001), IgA (MD, 0.20; 95% CI, 0.02-0.37; P = 0.03), CD4⁺ (MD, 2.02; 95% CI, 0.82-3.22; P = 0.001) and CD4⁺/CD8⁺ (MD, 0.07; 95% CI, 0.02-0.12; P = 0.008). However, there were no significant differences (P > 0.05) in terms of prealbumin (P = 0.08), IgM (P = 0.25), postoperative complications (P = 0.18), and body weight (P = 0.25) between the two groups. For gastric cancer patients with nutritional risk, preoperative oral nutritional supplements for 5-7 days may effectively reduce the postoperative inflammatory response, enhance immune function and improve the nutritional status of patients.