Pre-Operative Immunonutrition Enhances Postoperative Outcomes and Elevates Tumor-Infiltrating Lymphocyte Counts in Colorectal Cancer Patients: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objective

This study (CRD42023464989) aimed to explore the effects of pre-operation immunonutrition on safety and immune related factors in colorectal cancer patients undergoing surgery.

Methods

We systematically searched PubMed, Embase, and Wanfang databases to collect all clinical randomized controlled trials of the application of pre-operation immunonutrition for patients with colorectal cancer, published until July 2023. The primary outcomes were safety and immune related factors.

Results

A total of 16 studies were finally included. Preoperative immunonutrition could reduce the postoperative infection rate (risk ratio (RR) = 0.56, 95% confidence interval (CI): 0.36, 0.88; p = .01), and wound infection rate (RR = 0.44, 95% CI: 0.27, 0.70; p < .001) in patients with colorectal cancer. For length of stay (mean difference (MD) = −1.10, 95% CI: −2.70, 0.49; p = .17), it was similar between groups. Meanwhile, patients in the pre-operation immune nutrition group also had significantly increased infiltrative lymphocytes CD₁₆⁺ (MD = 0.04, 95% CI: 0.02, 0.06; p < .001), and CD₅₆⁺ (MD = 0.05, 95% CI: 0.03, 0.06; p < .001) cells in the tumor tissues, compared to the control group.

Conclusion

Immunonutrition intervention has the potential to reduce postoperative infectious complications and improve tumor infiltrative lymphocytes in patients with colorectal cancer undergoing surgery.

Acknowledgements

We greatly thank the Department of Gastroenterology Surgery and Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine for technical advice.

Authors Contributions

All authors participant in the study conception, design, contributed to, and agreed the final approval of the submitted version.

Mingqi Zhang, Guofeng Chen, and Xiaoli Jin participanted in the data collection and interpretation of data.

Jun Wang, and Shaojun Yu contributed to the completion of the table and figures.

All authors contributed to the writing of the manuscript.

Ethics Statement

An ethics statement is not applicable because this study is based exclusively on published literature.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Data Availability Statement

The supportive data of this manuscript are all included in this study.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (82203452), Health Science and Technology Project of Zhejiang Province (2022RC165), Clinical Research Fund of Zhejiang Medical Association (2021ZYC-A68).