***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients . The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre r and omised controlled trial to evaluate routine home enteral nutrition in these patients . Methods Patients undergoing oesophagectomy or total gastrectomy were r and omised to either six weeks of home feeding through a jejunostomy ( intervention ) , or treatment as usual ( control ) . Intervention comprised overnight feeding , providing 50 % of energy and protein requirements , in addition to usual oral intake . Primary outcome measures were recruitment and retention rates at six weeks and six months . Nutritional intake , nutritional parameters , quality of life and healthcare costs were also collected . Interviews were conducted with a sample of participants , to ascertain patient and carer experiences . Results Fifty-four of 112 ( 48 % ) eligible patients participated in the study over the 20 months . Study retention at six weeks was 41/54 patients ( 76 % ) and at six months was 36/54 ( 67 % ) . At six weeks , participants in the control group had lost on average 3.9 kg more than participants in the intervention group ( 95 % confidence interval [ CI ] 1.6 to 6.2 ) . These differences remained evident at three months ( mean difference 2.5 kg , 95 % CI −0.5 to 5.6 ) and at six months ( mean difference 2.5 kg , 95 % CI −1.2 to 6.1 ) . The mean values observed in the intervention group for mid arm circumference , mid arm muscle circumference , triceps skin fold thickness and right h and grip strength were greater than for the control group at all post hospital discharge time points . The economic evaluation suggested that it was feasible to collect re source use and EQ-5D data for a full cost-effectiveness analysis . Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial : 1 ) a positive experience , 2 ) the reasons for taking part , and 3 ) uncertainty of the study process . Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible , safe and acceptable to patients and their carers . Whether home enteral feeding as ’ usual practice ’ is a cost-effective therapy would require confirmation in an appropriately powered , multi-centre study .Trial registration UK Clinical Research Network ID 12447 ( main trial , first registered 30 May 2012 ) ; UK Clinical Research Network ID 13361 ( qualitative sub study , first registered 30 May 2012 ) ; Clinical Trials.gov NCT01870817 ( first registered 28 May 2013 We investigated the impact of early enteral nutrition ( EEN ) and parenteral nutrition ( PN ) on prealbumin ( PA ) and high-sensitivity C-reactive protein ( hs-CRP ) in patients after gastric cancer surgery . Sixty-eight selected patients undergoing gastric cancer surgery were r and omly divided into the EEN ( N = 34 ) and PN ( N = 34 ) groups . Body weight ( BW ) , serum albumin ( ALB ) , transferrin ( TF ) , PA , hs-CRP , length of hospital stay , cost of postoperative nutritional support , and incidence of complications were compared between groups . On postoperative day 7 , the BW , TF , ALB , and PA for both groups were significantly decreased compared with the values obtained on preoperative day 1 ( P < 0.01 ) . A significant decrease was observed in TF and PA in the PN group compared with the EEN group ( P < 0.01 ) . There was no significant difference in BW and ALB between the two groups ( P > 0.05 ) . The hs-CRP level of both groups was significantly higher than on preoperative day 1 . There was a significant increase in hs-CRP in the PN group compared with the EEN group ( P < 0.01 ) . The anal exhaust time , length of hospital stay , and nutritional support cost were significantly shorter or lower in the EEN group than in the PN group ( P < 0.01 ) . There was no significant difference in the incidence of complications between the two groups ( P > 0.05 ) . EEN helps regulate the postoperative response of patients after gastric cancer surgery , promotes rehabilitation , and accelerates the recovery of gastrointestinal function .  Furthermore , EEN has the advantage of being inexpensive OBJECTIVE To evaluate the influence of postoperative immunonutrition on immune and nutritional parameters in patients with gastric carcinoma . METHODS From September 2002 to August 2003 , 40 patients with gastric carcinoma who had undergone major surgery were r and omly divided into an immunonutrition group and st and ard nutrition group , each of 20 patients . On postoperative Day 2 , patients in the st and ard nutrition group received a st and ard enteral formula , while those in the immunonutrition group received an enteral formula enriched with glutamine , arginine and omega-3 fatty acids . Nutritional support was continued for 7 days . Blood sample s were obtained to determine plasma albumin , prealbumin and transferrin on Days 0 , 5 and 9 . On Days 0 , 1 and 9 , blood sample s were collected to detect immunoglobulin ( Ig ) A , IgG , IgM , CD4 and CD8 cell counts , the ratio of CD4/CD8 , interleukin (IL)-2 , IL-6 and tumour necrosis factor (TNF)-alpha , respectively . RESULTS There were no significant differences between the two groups in protein and immune parameters preoperatively and no significant differences in management perioperatively . No serious adverse effects were recorded with the two formulas . Postoperative procedures were smooth in both groups . On Day 9 , serum levels of prealbumin and transferrin were higher in the immunonutrition group than in the st and ard nutrition group ( p<0.01 ) . After 7 days ' nutritional support , patients in the immunonutrition group had higher levels of immunoglobulin , CD4 cell counts , CD4/CD8 ratio and IL-2 than those in the control group , whereas IL-6 and TNF-alpha levels were significantly lower in the immunonutrition group . CONCLUSION Compared with st and ard enteral nutrition , enteral immunonutrition can improve defence mechanisms and modulate inflammatory action after major elective surgery for gastric carcinoma Background / Aim Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications . However , many questions still remain unresolved in this area , such as the length of diet administration , diet composition , and the mechanisms involved . We performed an open , r and omized , triple-arm study comparing the effect of two perioperative feeding regimens with a postoperative one . Methods 46 c and i date s for major elective surgery for malignancy in the upper gastrointestinal tract were r and omized to drink preoperatively either 1 L of an immunoenriched formula ( Impact ) for 5 days ( IEF group ) or 1 L of Impact plus ( Impact enriched with glycine ) for 2 days ( IEF plus group ) . The same product as the patient received preoperatively was given to both groups for 7 days postoperatively . In the control group ( CON group ) , patients only received Impact for 7 days postoperatively ; there was no preoperative treatment . The main outcome measures were postoperative C-reactive protein ( CRP ) serum levels . Results In the two preoperatively supplemented groups ( treatment groups ) , perioperative endotoxin levels , CRP ( postoperative day 7 ) , and TNF-α ( postoperative days 1 and 3 ) levels were significantly lower compared to the CON group ( p < .01 ) . Furthermore , the length of postoperative IMU/ICU stay ( Impact 1.9 ± 1.3 days ; Impact plus 2.2 ± 1.1 days ; control group 5.9 ± 0.8 days ) and length of hospital stay ( Impact 19.7 ± 2.3 days ; Impact plus 20.1 ± 1.3 days ; control group 29.1 ± 3.6 days ) were both reduced in the treatment groups compared to the control group . Infectious complications ( Impact 2/14 ( 14 % ) ; Impact plus 5/17 ( 29 % ) ; control group 10/15 ( 67 % ) ) also showed a trend toward reduction in the treatment groups . Conclusions Perioperative administration of an immunoenriched diet significantly reduces systemic perioperative inflammation and postoperative complications in patients undergoing major abdominal cancer surgery , when compared with postoperative diet administration alone . A shortened preoperative feeding regimen of 2 days with Impact enriched with glycine ( Impact plus ) was as effective as Impact administered for 5 days preoperatively We studied the effects of enteral nutrition ( EN ) support initiated 1 week before surgery on postoperative nutritional status , immune function , and inflammatory response in gastric cancer patients . A total of 200 gastric cancer patients were r and omly divided into two groups : EN starting 1 week before surgery ( study group ) and EN starting early after surgery ( control group ) . The two groups received EN support , following different therapeutic schedules , until the 9th day after operation . In the patients , body weight , skinfold thickness , upper-arm circumference , white blood cell count , albumin , prealbumin , C-reactive protein , peripheral immunoglobulins ( IgA , IgG , and IgM ) , T lymphocyte subsets , interleukin-6 , and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery . There was no statistically significant difference in the results of recovery time of passage of gas by anus , abdominal distension , stomachache , blood glucose , hepatic and renal functions , and electrolytes between the two groups of patients ( P > 0 . 05 ) . Adverse reactions occurred to both groups at 1 and 2 days after operation . Such conditions was improved after the intravenous drip rate was adjusted . The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation ( P < 0 . 05 ) . The levels rose when the research was finished ( P < 0 . 05 ) . The prealbumin level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The IgG level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The two groups of inflammatory reaction indicators of the study group were lower than those of the control group at 10 days after operation ( P < 0 . 05 ) . This study indicates that appropriate preoperative EN support for gastric cancer patients can improve their postoperative nutritional status and immune function , can reduce inflammatory response , and is more conducive to the recovery of patients OBJECTIVE The aim of this study is to investigate the effect of low-nitrogen and low-calorie parenteral nutrition ( PN ) combined with enteral nutrition ( EN ) on the inflammatory cytokines and immune function in patients with gastric cancer . PATIENTS AND METHODS Between May 2012 and May 2014 , 90 patients undergoing surgery for gastric cancer in our institution were involved in this double blind placebo study and r and omly divided into experimental group and control group , 45 patients of each group . Patients in the control group would receive total parenteral nutrition ( TPN ) whereas patients in the experimental group would be supported with low-nitrogen and low-calorie PN combined with EN . RESULTS On the 7th postoperative day 7 , levels of IgA , IgM and IgG in experimental group were significantly higher than those in the control group and preoperative values ( p < 0.05 ) . CRP level was significantly lower than that of controls and preoperatively ( p < 0.05 ) . Levels of IL-2 and TNF-α were significantly higher than those of controls and preoperatively ( p < 0.05 ) . CONCLUSIONS As low-nitrogen and low-calorie PN combined with EN can effectively improve the immune function , reduce the inflammatory reactions and improve the postoperative quality of life ( QoL ) and prognosis in patients with gastric cancer , it is suitable for clinical application BACKGROUND Although malnutrition contributes to morbidity , studies of pre- and postoperative nutrition often include well-nourished patients unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology . This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with postoperative complications and re source use in patients who receive no preoperative nutrition support  and reinterprets the results of several conflicting r and omized , prospect i ve studies in this context . METHODS This is a retrospective cohort study of 526 surgical patients who had preoperative serum albumin levels measured and were undergoing elective esophageal , gastric , pancreaticoduodenal , or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not .  RESULTS Most medical records contained inadequate analysis of preoperative nutritional status , but preoperative albumin correlated inversely with complications , length of stay , postoperative stay , intensive care unit ( ICU ) stay , mortality , and resumption of oral intake .  Patients undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate at most albumin levels , whereas colonic surgery result ed in lower complication rates at the same albumin levels 
    Output:
    
It was found that the risk of surgical site infection was significantly lower in patients who received perioperative immunonutrition  than those given st and ard nutrition .
Furthermore , hospital stay was significantly shorter in patients receiving immunonutrition or early enteral nutrition after surgical resection of gastric cancer .
Perioperative immunonutrition also significantly reduced white blood cell counts and the level of C-reactive protein in the patients .
However , neither CD4 + T cells nor inflammatory cytokines were significantly affected even though immunonutrition was in favor .
These findings suggested that patients with gastrointestinal cancer may benefit from perioperative immunonutrition support by reducing surgery-associated complications and shortening hospital stay .