Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy

// Guo-Min Song 1, * , Xiao-Ling Liu 2, * , Wei Bian 3, * , Jing Wu 2, * , Yong-Hong Deng 4 , Hui Zhang 4 , Xu Tian 2 1 Department of Nursing, Tianjin Hospital, Tianjin 300211, China 2 Department of Gastroenterology, Chongqing Cancer Institute and Hospital and Cancer Center, Chongqing 400030, China 3 Ophthalmology Department, Southwest Hospital, Third Military Medical University, Chongqing 400031, China 4 Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China * These authors contributed equally to this work Correspondence to: Xu Tian, email: yxtx880919@hotmail.com Keywords: stomach neoplasm, surgical resection, enteral nutrition, immunonutrition, meta-analysis Received: June 11, 2016 Accepted: February 10, 2017 Published: February 21, 2017 ABSTRACT Objectives: Optimal 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. Results: We 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 Methods: We 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. Conclusions: 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.