Efficacy and safety of home enteral nutritional support in postoperative gastric cancer patients: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Poor nutritional status markedly elevates postoperative risk in patients with gastric cancer. Evidence regarding the benefits and safety of home enteral nutrition (HEN) after discharge remains inconclusive. This meta-analysis assessed the effectiveness and safety of HEN following gastrectomy based on available studies.

METHODS

This systematic review followed the PRISMA guidance. We searched the Cochrane Library, Web of Science, Embase, PubMed, CNKI, Wanfang, SinoMed, VIP, and ProQuest from inception to December 11, 2024, and screened trial registration and preprint platforms. Randomized controlled trials (RCTs) and quasi-experimental studies published in English or Chinese were included. Risk of bias was assessed using the Cochrane ROB-2 and ROBINS-I tools, and meta-analyses were conducted using R (version 4.4).

RESULTS

Sixteen RCTs and four quasi-experimental studies involving 2969 patients were included. HEN demonstrated a positive effect on nutritional intake and reduced weight loss (MD = -1.06; 95% CI: -1.63 to -0.48; 95% PI: -2.12 to 0.01; p < 0.05; τ2 = 0.15; I2 = 45.6%). HEN improved total protein (SMD = 0.35; 95% CI: 0.04 to 0.65; 95% PI: -0.52 to 1.21; p < 0.05; τ2 = 0.13; I2 = 77.2%), albumin (SMD = 0.40; 95% CI: 0.03 to 0.76; 95% PI: -0.79 to 1.58; p < 0.05; τ2 = 0.27; I2 = 88.2%), prealbumin (SMD = 0.60; 95% CI: 0.20 to 1.01; 95% PI: -0.32 to 1.53; p < 0.05; τ2 = 0.11; I2 = 63.3%), and subjective nutritional status (MD = -1.66; 95% CI: -2.53 to -0.79; 95% PI: -3.85 to 0.53; p < 0.05; τ2 = 0.61; I2 = 87.0%). HEN did not increase readmission or complication rates and improved quality of life, particularly physical function (MD = 6.36; 95% CI: 2.55 to 10.16; 95% PI: -0.97 to 13.68; p < 0.05; τ2 = 5.93; I2 = 61.8%) and appetite loss (MD = -6.87; 95% CI: -11.03 to -2.71; 95% PI: -12.66 to -1.08; p < 0.05; τ2 = 1.06; I2 = 9.0%).

CONCLUSIONS

HEN appears promising in reducing postoperative weight loss, improving nutritional status, supporting chemotherapy tolerance, and enhancing quality of life; however, its overall efficacy remains uncertain.