Effect Of Preoperative Oral Immunonutrition Supplement On Immune Function Of Patients With Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemotherapy

BackgroundIn recent years,preoperative nutritional support has been paid great attention,especially for patients who received surgical reconstruction of the digestive tract such as esophagectomy.Preoperative nutritional support therapy can accelerate the postoperative recovery of patients with esophageal cancer and reduce the incidence of complications and hospital stay.In addition,immune suppression,nausea,and vomiting may lead to poor immune and nutritional status of patients with esophageal cancer who underwent neoadjuvant chemotherapy,which is not conducive to surgery.Therefore,preoperative immunonutrition supplement is necessary for patients with esophageal cancer who underwent neoadjuvant chemotherapy.ObjectiveTo explore the effect of preoperative oral immunonutrition supplement on immune function and clinical outcome of patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy.MethodThe 124 patients who received neoadjuvant chemotherapy in Jinling hospital from January 2018 to September 2020 were retrospectively analyzed.According to propensity score matching(1:2),they were divided into the experimental group and the control group.There were 21 patients in the experimental group and 42 patients in the control group.The experimental group received routine diet and immunonutrition supplement(glutamine,arginine,ω-3 fatty acids,and RNA);the control group received only routine diet.The primary outcomes were immune and nutritional indicators changes,including immunoglobulin M(IgM),immunoglobulin A(IgA),immunoglobulin G(IgG)and albumin(ALB)measured on preoperative day 7,preoperative day 1,postoperative day 1 and postoperative day 7.The secondary outcomes of the study were postoperative complications,length of hospital stay and adverse reactions.ResultsThere was no significant difference in baseline data between the two groups.Compared with the control group,IgA in the experimental group increased significantly on the 7th day after operation(P=0.017),but the IgM level in the experimental group was significantly lower than the control group(P=0.007).The incidence of overall complications and pneumonia in the experimental group was significantly lower than that in the control group(P=0.028;P=0.024).There was no significant difference in IgG,ALB,length of hospital stays and adverse reactions between the two groups(P=0.3 15;P=0.303;P=0.081;P=0.108).ConclusionPreoperative immunonutrition supplement after neoadjuvant chemotherapy for esophageal squamous cell carcinoma is an effective strategy to improve the postoperative immune function of patients with esophageal squamous cell carcinoma and could reduce the incidence of infectious complication.More patients,larger scale and more clinical randomized controlled trials are needed to verify and explore the effect of immunonutrition supplement.