Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial

Abstract Background: Although current guidelines recommend preoperative immunonutrition for cachectic gastric cancer patients, the strength of the recommendation is weak, and the level of evidence is low. The benefits of preoperative immunonutrition still remain controversial. Patients and Methods: During the period from June 2022 to April 2023, 112 patients with gastric cancer cachexia were enrolled in the study and randomly assigned in a 1:1 ratio to receive either preoperative enteral immunonutrition support (IN, n=56) or standard enteral nutrition support (SEN, n=56). The primary endpoint was the incidence of infectious complications, and the secondary endpoints included the nutritional indicators, inflammatory markers, immune parameters, postoperative recovery and complications and astrointestinal intolerance reactions. Results: The occurrence rate of infectious complications in patients who received preoperative immunonutrition support was significantly lower than that in the SEN group (21.4% vs 37.5%, P=0.040). The overall incidence of postoperative complications in the IN group was significantly lower than that in the SEN group (28.6% vs 44.6%, P =0.049). In terms of laboratory measurements, the IN group had significantly lower white blood cell (WBC) levels before surgery, on the first day after surgery, and on the fifth day after surgery compared to the SEN group ( P =0.011; P =0.019; P =0.034). The IN group also had significantly lower serum C-reactive protein (CRP) levels before surgery, on the first day after surgery, and on the third day after surgery compared to the SEN group ( P =0.005; P =0.017; P =0.042). On the third day after surgery, the IL-6 levels in the IN group were significantly lower than those in the SEN group. Furthermore, the IN group had significantly higher blood lymphocytes levels on the third and fifth day after surgery compared to the SEN group ( P =0.016; P =0.011). The IN group also had significantly higher serum IgA levels before surgery and on the third day after surgery compared to the SEN group ( P =0.048). In terms of clinical outcomes, the IN group had a shorter duration of antibiotic use ( P =0.048), shorter hospital stay ( P =0.018), and lower total hospital costs ( P =0.034) compared to the SEN group. The IN group also experienced significantly less weight loss after surgery ( P =0.043). Conclusion: Preoperative administration of immunonutrition formula has a positive impact on the incidence of infectious complications in patients with gastric cancer cachexia after surgery. It improves patients' inflammatory and immune status, shortens hospital stays, and reduces healthcare costs. Preoperative use of immunonutrition may contribute to the improvement of prognosis in this high-risk population.