Clinical impact of early enteral nutrition support on gastrointestinal function, nutritional status, liver function, and immune function in liver cancer patients.

OBJECTIVE

This randomized controlled trial aimed to evaluate the clinical impact of early enteral nutrition (EEN) on postoperative gastrointestinal function, nutritional status, liver function, and immune function in primary liver cancer patients.

METHODS

A total of 80 patients treated between December 2022 and December 2023 were randomly assigned to two groups: experimental group (EEN, n = 40) and control group (total parenteral nutrition, TPN, n = 40). Both groups received isocaloric and isonitrogenous nutritional support after surgery. The primary outcome was the change in serum albumin (ALB) levels from baseline to postoperative day 7. Secondary outcomes included gastrointestinal recovery markers, nutritional markers [diamine oxidase (DAO) and prealbumin (PA)], liver function markers [cholinesterase (ChE), aspartate aminotransferase (AST), and alanine aminotransferase (ALT)], immune markers (CD4+, CD8+, and the CD4+/CD8+ ratio), adverse reactions, and exploratory clinical outcomes (length of hospital stay, infection rate, mortality, readmission rate, and postoperative liver failure). Data were analyzed using repeated measures ANOVA for longitudinal outcomes, with effect sizes (partial η2, Cohen's d) and 95% confidence intervals.

RESULTS

The EEN group showed faster recovery in liquid diet intake, bowel movements, and defecation times (all p < 0.001). For the primary outcome, the EEN group had significantly higher postoperative ALB levels [30.5 ± 2.5 vs. 26.2 ± 2.7 g/L; mean difference 4.3 g/L (95% CI: 2.8-5.8), p < 0.001]. Repeated measures ANOVA revealed significant group × time interactions for ALB (η2 p = 0.22), DAO (η2 p = 0.19), PA (η2 p = 0.17), ChE (η2 p = 0.22), AST (η2 p = 0.20), ALT (η2 p = 0.18), CD4+ (η2 p = 0.21), CD8+ (η2 p = 0.14), and the CD4+/CD8+ ratio (η2 p = 0.19) (all p < 0.001). The EEN group also had a significantly shorter hospital stay (12.5 ± 3.2 vs. 16.8 ± 4.1 days, p < 0.001) and fewer adverse reactions (2.5% vs. 20.0%, p = 0.013). Differences in infection rates (5.0% vs. 15.0%), readmission rates (2.5% vs. 7.5%), and liver failure rates (2.5% vs. 10.0%) did not reach statistical significance.

CONCLUSION

In this randomized controlled trial, early enteral nutrition support significantly improved postoperative gastrointestinal recovery, enhanced nutritional and liver function parameters, boosted immune markers, and shortened hospital stay compared to total parenteral nutrition, with fewer adverse reactions. These findings support the clinical use of EEN in patients undergoing liver cancer surgery. Larger multicenter trials are warranted to confirm the effects on infection rates, liver failure, and long-term survival.