The Effect of Early Enteral Nutrition under the ERAS Model on Gastrointestinal and Immune Function Recovery in Patients Undergoing Gastric Tumor Surgery
Authors: Wang Zikun , Peng Wenrui , Zhang Jin 
Published: December 2024

AIM: Patients with gastric malignant tumors usually undergo surgical treatment when indicated. Surgical intervention causes significant trauma and can lead to considerable stress responses in patients. These patients experience increased malnutrition along with reduced immune function, which ultimately leads to the occurrence of postoperative complications. Therefore, this study explored the effects of early enteral nutrition on gastrointestinal and immune function in patients undergoing gastric cancer surgery under the Enhanced Recovery After Surgery (ERAS) model, aiming to support early postoperative recovery. 
METHODS: A retrospective analysis was conducted on the clinical data obtained from gastric tumors patients who underwent surgery in the Affiliated Hospital of Jiangsu University, between January 2019 and December 2022. Based on the gastrointestinal management approaches, the patients were divided into a control group (n = 92) and an observation group (n = 92). The control group received routine gastrointestinal management and parenteral nutrition support, while the observation group underwent early enteral nutrition support under the ERAS model. The initial postoperative flatulence, the first instance of eating, and the initial bowel movement, as well as serum nutritional indicators [albumin (Alb), prealbumin (PA), hemoglobin (Hb)], immune markers [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)], inflammatory markers [white blood cell (WBC), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6)] were evaluated at different time points before and after surgery. Furthermore, the incidence of postoperative complications (abdominal distension, diarrhea, and infection) and the length of post-surgery hospitalization were documented for both patient cohorts. 
RESULTS: The observation group showed shorter time to first postoperative flatus, earlier food consumption, and an advanced first bowel movement than the control group (p < 0.05). On the third day after surgery, the serum concentrations of Alb, PA, Hb, IgG, IgM, and IgA were diminished in both groups compared to their preoperative levels (p < 0.05). Moreover, on the 7th day after surgery, the serum levels of Alb, PA, Hb, IgG, IgM, and IgA increased in both groups compared to the 3rd day (p < 0.05) but remained lower than before surgery levels (p < 0.05). Additionally, the serum Alb, PA, Hb, IgG, IgM, and IgA levels were significantly higher in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Three days following surgery, WBC, hs-CRP, and IL-6 levels were elevated in both groups compared to their preoperative levels (p < 0.05). On the 7th day after surgery, WBC, hs-CRP, and IL-6 levels decreased in both groups compared to the 3rd day after surgery (p < 0.05) but remained higher than preoperative levels (p < 0.05). Moreover, WBC, hs-CRP, and IL-6 levels were relatively lower in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Furthermore, the observation group exhibited a decreased overall frequency of postoperative complications compared to the control group (p < 0.05), along with shorter hospitalization following the surgery (p < 0.05). 
CONCLUSIONS: Our findings indicate that early enteral nutrition under the ERAS model can better promote the recovery of gastrointestinal and immune functions in patients undergoing gastric tumor surgery while reducing postoperative complications and facilitating early discharge of patients.