{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:07:01Z","timestamp":1790140021016,"version":"4.0.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 80 patients treated between December 2022 and December 2023 were randomly assigned to two groups: experimental group (EEN,\n n<\/jats:italic>\n \u202f=\u202f40) and control group (total parenteral nutrition, TPN,\n n<\/jats:italic>\n \u202f=\u202f40). 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\n +<\/jats:sup>\n , CD8\n +<\/jats:sup>\n , and the CD4\n +<\/jats:sup>\n \/CD8\n +<\/jats:sup>\n 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 \u03b7\n 2<\/jats:sup>\n , Cohen\u2019s d) and 95% confidence intervals.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The EEN group showed faster recovery in liquid diet intake, bowel movements, and defecation times (all\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). For the primary outcome, the EEN group had significantly higher postoperative ALB levels [30.5\u202f\u00b1\u202f2.5 vs. 26.2\u202f\u00b1\u202f2.7\u202fg\/L; mean difference 4.3\u202fg\/L (95% CI: 2.8\u20135.8),\n p<\/jats:italic>\n \u202f&lt;\u202f0.001]. Repeated measures ANOVA revealed significant group \u00d7 time interactions for ALB (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.22), DAO (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.19), PA (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.17), ChE (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.22), AST (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.20), ALT (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.18), CD4\n +<\/jats:sup>\n (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.21), CD8\n +<\/jats:sup>\n (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.14), and the CD4\n +<\/jats:sup>\n \/CD8\n +<\/jats:sup>\n ratio (\u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u202f=\u202f0.19) (all\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The EEN group also had a significantly shorter hospital stay (12.5\u202f\u00b1\u202f3.2 vs. 16.8\u202f\u00b1\u202f4.1\u202fdays,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and fewer adverse reactions (2.5% vs. 20.0%,\n p<\/jats:italic>\n \u202f=\u202f0.013). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1769787","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:50:26Z","timestamp":1790139026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical impact of early enteral nutrition support on gastrointestinal function, nutritional status, liver function, and immune function in liver cancer patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Sufang","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinchun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhen","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honggui","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Quality Control Office, Huai\u2019an No. 4 People\u2019s Hospital","place":["Huai\u2019an, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1159\/000539349","article-title":"Hepatocellular carcinoma: prevention, diagnosis, and treatment","volume":"33","author":"Feng","year":"2024","journal-title":"Med Princ Pract"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3390\/ijms25042168","article-title":"All three AKT isoforms can upregulate oxygen metabolism and lactate production in human hepatocellular carcinoma cell lines","volume":"25","author":"Tian","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1387587","DOI":"10.3389\/fonc.2024.1387587","article-title":"Trend analysis and age-period-cohort effects on morbidity and mortality of liver cancer from 2010 to 2020 in Guangzhou","volume":"14","author":"Wang","year":"2024","journal-title":"China Front Oncol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"266","DOI":"10.4240\/wjgs.v16.i2.266","article-title":"Prognostic impact of preoperative nutritional and immune inflammatory parameters on liver cancer","volume":"16","author":"Bae","year":"2024","journal-title":"World J Gastrointest Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s13346-024-01621-x","article-title":"Plant-derived exosome-like nanoparticles for microRNA delivery in cancer treatment. 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