Enteral immunonutrition versus standard enteral nutrition for patients undergoing oesophagogastric resection for cancer

A best evidence topic in surgery was written according to a structured protocol. The question addressed was "In cancer patients undergoing oesophageal or gastric resection for cancer and requiring postoperative nutritional support, does enteral immunonutrition confer additional clinical benefits as compared to standard enteral nutrition? Two hundred and fifty-eight papers were identified by a search of the MEDLINE and EMBASE databases, of which six randomized controlled trials represented the best evidence to answer this clinical question. The authors, journal, date and country of publication, patient group, study group, relevant outcomes and results of these papers were tabulated. All six of these randomised controlled trials compared the clinical benefits of standard enteral nutrition with those of enteral nutrition supplemented with a variety of immune-modulating substances. The studies failed to demonstrate consistent differences in patients' postoperative clinical course, complications, length of hospital stay and inflammatory marker levels. Hence although there is reasonable evidence to suggest that immunonutrition improves humoral immunity as opposed to cellular immunity, this improvement does not result in reductions in infection rates or reduced hospital stay. There is currently not enough evidence to recommend routine immunonutrition in all patients undergoing oesophageal or gastric resection for cancer.