Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7405-7415
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7405
Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice
Bing-Qiang Ma, Shi-Yong Chen, Ze-Bin Jiang, Biao Wu, Yu He, Xin-Xin Wang, Yuan Li, Peng Gao, Xiao-Jun Yang
Bing-Qiang Ma, Ze-Bin Jiang, Peng Gao, Xiao-Jun Yang, Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Shi-Yong Chen, Biao Wu, Yuan Li, School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
Yu He, Xin-Xin Wang, School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Author contributions: Ma BQ, Chen SY, and Jiang ZB contributed equally to this work and should be considered as co-first authors; Ma BQ, Chen SY, Jiang ZB, and Yang XJ conceived the experiment; Ma BQ and Jiang ZB analyzed the results; Ma BQ and Chen SY wrote the original draft; Ma BQ, Chen SY, Jiang ZB, Wu B, He Y, Wang XX, Li Y, Gao P, and Yang XJ conducted the experiment; All the authors revised the manuscript and approved the final version.
Supported by National Natural Science Foundation of China, No. 81660398; and The Hospital Key Program of National Scientific Research Cultivation Plan, No. 19SYPYA-12.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Gansu Provincial Hospital (Approval No. 2016-036).
Clinical trial registration statement: This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx). The registration identification number is ChiCTR2000034561.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Yang, MD, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. yangxjmd@aliyun.com
Received: August 27, 2020
Peer-review started: August 27, 2020
First decision: November 3, 2020
Revised: November 15, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: December 14, 2020
Processing time: 108 Days and 15.5 Hours
Abstract
BACKGROUND

Most cholangiocarcinoma patients with malignant obstructive jaundice (MOJ) have varying degrees of malnutrition and immunodeficiency preoperatively. Therefore, perioperative nutritional support has important clinical significance in the treatment of cholangiocarcinoma.

AIM

To investigate the effects of postoperative early enteral nutrition (EEN) on immunity function and clinical outcomes of cholangiocarcinoma patients with MOJ.

METHODS

This prospective clinical study included 60 cholangiocarcinoma patients with MOJ who underwent surgery. The patients were randomly divided into an experimental group and a control group according to the nutrition support modes. The control group received postoperative total parenteral nutrition (TPN), whereas the experimental group received postoperative EEN and parenteral nutrition (PN; EEN + PN). The clinical outcomes, postoperative immune function, incidences of surgical site infection and bile leakage, intestinal function recovery time, average hospitalization days, and hospitalization expenses of the two groups were assessed on postoperative days (PODs) 1, 3, and 7.

RESULTS

The CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T cell count and the immunoglobulin (Ig) G, IgM, and IgA levels in the EEN + PN group were significantly higher than those in the TPN group on PODs 3 and 7 (P < 0.05), whereas no significant differences in the CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T cell counts and IgG, IgM, and IgA levels before operation and on POD 1 were found between the two groups (P > 0.05). The intestinal function recovery time and postoperative hospital stay were shorter (P < 0.001 for both) in the EEN + PN group than in the TPN group. The hospitalization expenses of the EEN + PN group were lower than those of the TPN group (P < 0.001). However, the incidence of abdominal distension was higher than in the EEN + PN group than in the TPN group (P < 0.05). The incidence rates of biliary leakage and surgical site infection were not significantly different between the two groups (P > 0.05).

CONCLUSION

A postoperative EEN program could reduce the incidence of postoperative complications and improve the clinical outcomes and immune functions of cholangiocarcinoma patients with MOJ and is thus beneficial to patient recovery.

Keywords: Clinical outcomes; Early enteral nutrition; Immune function; Nutritional status; Malignant obstructive jaundice; Cholangiocarcinoma

Core Tip: The aim of this prospective clinical trial was to investigate the effects of postoperative early enteral nutrition (EEN) on immunity function and clinical outcomes of cholangiocarcinoma patients with malignant obstructive jaundice (MOJ). Patients were randomly divided into the early enteral nutrition and parenteral nutrition (EEN+PN) and total parenteral nutrition (TPN) groups. As a result, the CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T cell counts, and the immunoglobulin (Ig) G, IgM, and IgA levels in the EEN+PN group were significantly higher than those in the TPNgroup on postoperative days 3 and 7 (P < 0.05). A postoperative EEN program could improve the clinical outcomes and immune functions of cholangiocarcinoma patients with MOJ and is thus beneficial to patient recovery.