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Peer-reviewedCC BY 4.0Frontiers in Genetics

Early enteral nutrition and perioperative peripheral immune-cell dynamics after gastrectomy for gastric cancer

  • Hanmei Jiang1
  • Yajie He2
  • Min Tian3
  • Yingsheng Xu4
  • Xiaohua Guo5
5 affiliations
  1. 1Department of Gastroenterology, Qinghai University Affiliated Hospital, Xining, Qinghai, China
  2. 2Department of General Surgery, Ezhou Central Hospital, Ezhou, Hubei, China
  3. 3Department of Outpatient, The General Hospital of Western Theater Command of Chinese People’s Liberation Army, Chengdu, Sichuan, China
  4. 4Department of Clinical Nutrition, Ezhou Central Hospital, Ezhou, China
  5. 5Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an City, Shaanxi, China
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Abstract

Background: Immune checkpoint inhibitors (ICIs) have changed advanced gastric cancer (GC) treatment, but response remains heterogeneous. Radical gastrectomy causes transient perioperative immune perturbations. We evaluated whether early enteral nutrition (EEN) was associated with preservation of peripheral immune-cell phenotypes and improved postoperative outcomes. Immunotherapy-related interpretations were exploratory; no ICI therapy or molecular pathway assays were performed.

Methods: This retrospective cohort included 120 patients undergoing radical gastrectomy (January 2022-December 2023): EEN within 24 h (n = 60) or traditional delayed nutrition (TN) on postoperative day (POD) 3–5 (n = 60). The primary endpoint was the POD 7 CD4+/CD8+ ratio. Exploratory secondary endpoints included immune-cell counts, 30-day complications, nutritional and gastrointestinal recovery, hospital utilization, and quality-of-life measures. Driver mutations described baseline context only; no mutation-stratified outcome analyses were performed.

Results: On POD 7, the CD4+/CD8+ ratio was higher with EEN than TN (1.42 ± 0.18 vs. 1.26 ± 0.21; mean difference, 0.16; 95% CI, 0.09-0.23; P < 0.001). CD4+ (512 ± 68 vs. 456 ± 72 cells/μL), CD3+ (1,235 ± 152 vs. 1,086 ± 168 cells/μL), and NK-cell counts (285 ± 42 vs. 248 ± 38 cells/μL) were also higher (all P < 0.001), whereas CD8+ counts did not differ (P = 0.743). Overall postoperative complications were lower with EEN (15.0% vs. 31.7%; risk ratio, 0.47; 95% CI, 0.23-0.96; P = 0.031), and postoperative hospital stay was shorter (10.3 ± 2.1 vs. 13.8 ± 2.9 days; P < 0.001). Secondary comparisons were exploratory and unadjusted for multiplicity.

Conclusion: Perioperative EEN was associated with better preservation of selected peripheral immune-cell phenotypes, fewer postoperative complications, and faster recovery after gastrectomy for GC. CD4+/CD8+ ratio and NK-cell counts are phenotypic markers, not direct measures of IFNG/IL2 or NFKB1/IL6 pathway activity. Immunotherapy implications remain hypothesis-generating and require prospective validation.

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Cite

BibTeXRIS
BibTeX
@article{jiang2026early,
  title = {{Early enteral nutrition and perioperative peripheral immune-cell dynamics after gastrectomy for gastric cancer}},
  author = {Hanmei Jiang and Yajie He and Min Tian and Yingsheng Xu and Xiaohua Guo},
  journal = {Frontiers in Genetics},
  year = {2026},
  month = oct,
  doi = {10.3389/fgene.2026.1931867},
  url = {https://doi.org/10.3389/fgene.2026.1931867},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Early enteral nutrition and perioperative peripheral immune-cell dynamics after gastrectomy for gastric cancer
AU  - Hanmei Jiang
AU  - Yajie He
AU  - Min Tian
AU  - Yingsheng Xu
AU  - Xiaohua Guo
PY  - 2026
DA  - 2026/10/22
JO  - Frontiers in Genetics
DO  - 10.3389/fgene.2026.1931867
UR  - https://doi.org/10.3389/fgene.2026.1931867
AB  - Background: Immune checkpoint inhibitors (ICIs) have changed advanced gastric cancer (GC) treatment, but response remains heterogeneous. Radical gastrectomy causes transient perioperative immune perturbations. We evaluated whether early enteral nutrition (EEN) was associated with preservation of peripheral immune-cell phenotypes and improved postoperative outcomes. Immunotherapy-related interpretations were exploratory; no ICI therapy or molecular pathway assays were performed.  Methods: This retrospective cohort included 120 patients undergoing radical gastrectomy (January 2022-December 2023): EEN within 24 h (n = 60) or traditional delayed nutrition (TN) on postoperative day (POD) 3–5 (n = 60). The primary endpoint was the POD 7 CD4+/CD8+ ratio. Exploratory secondary endpoints included immune-cell counts, 30-day complications, nutritional and gastrointestinal recovery, hospital utilization, and quality-of-life measures. Driver mutations described baseline context only; no mutation-stratified outcome analyses were performed.  Results: On POD 7, the CD4+/CD8+ ratio was higher with EEN than TN (1.42 ± 0.18 vs. 1.26 ± 0.21; mean difference, 0.16; 95% CI, 0.09-0.23; P < 0.001). CD4+ (512 ± 68 vs. 456 ± 72 cells/μL), CD3+ (1,235 ± 152 vs. 1,086 ± 168 cells/μL), and NK-cell counts (285 ± 42 vs. 248 ± 38 cells/μL) were also higher (all P < 0.001), whereas CD8+ counts did not differ (P = 0.743). Overall postoperative complications were lower with EEN (15.0% vs. 31.7%; risk ratio, 0.47; 95% CI, 0.23-0.96; P = 0.031), and postoperative hospital stay was shorter (10.3 ± 2.1 vs. 13.8 ± 2.9 days; P < 0.001). Secondary comparisons were exploratory and unadjusted for multiplicity.  Conclusion: Perioperative EEN was associated with better preservation of selected peripheral immune-cell phenotypes, fewer postoperative complications, and faster recovery after gastrectomy for GC. CD4+/CD8+ ratio and NK-cell counts are phenotypic markers, not direct measures of IFNG/IL2 or NFKB1/IL6 pathway activity. Immunotherapy implications remain hypothesis-generating and require prospective validation.
SN  - 1664-8021
ER  -