Oncology · Medical Literature
[The impact of early postoperative enteral nutrition on nutritional status and immune function in breast cancer patients after neoadjuvant therapy].
Abstract
Objective: To investigate the effects of early postoperative enteral nutrition on nutritional status, immune function, and postoperative recovery in breast cancer patients receiving neoadjuvant therapy. Methods: A total of 90 breast cancer patients who underwent neoadjuvant therapy at the Cancer Hospital, Chinese Academy of Medical Sciences from August 2024 to May 2025 were enrolled. A randomized controlled study design was adopted, and the patients were divided into a control group (n=45) and a study group (n=45) using a random number table method. The perioperative diet for both groups followed the nutritional principles of adequate energy, high protein, high vitamins, and low fat, ensuring a daily caloric intake of approximately 2 000 kcal per person. Patients in the study group additionally received an oral special medical purpose formula food for tumor nutrition. Nutritional intervention in both groups started on the first day after surgery and continued until the seventh day after surgery. Nutritional indicators, immune function parameters, and surgery-related complications were compared between the two groups before and after intervention. Results: Baseline characteristics were balanced between the study group and the control group. There were no statistically significant differences between the two groups in age, body mass index, Nutritional Risk Screening 2002 score, pathological type, or disease stage (all P＞0.05). Before the intervention, there were also no statistically significant differences in nutritional indicators (serum total protein, serum albumin) or immune function parameters (T lymphocyte subsets CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺ratio, immunoglobulins IgA, IgG, IgM) between the two groups (all P＞0.05). After the intervention, the nutritional indicator levels in the study group were significantly higher than those in the control group: serum total protein was (72.42±3.61) g/L vs (70.74±3.76) g/L (t=2.040, P=0.045); serum albumin was (42.96±2.20) g/L vs (42.02±1.97) g/L (t=2.027, P=0.046). Additionally, some immune function parameters in the study group were also better than those in the control group: CD3⁺ was 75.41%±7.72% vs 69.26%±8.55% (t=2.814, P=0.007); CD8⁺ was 31.39%±9.43% vs 26.30%±6.89% (t=2.230, P=0.030); the levels of IgA, IgG, and IgM in the study group were also significantly higher than those in the control group (all P＜0.05). In terms of postoperative recovery, the drainage tube removal time in the study group was significantly shorter than that in the control group [(17.05±5.65) days vs (19.59±5.54) days; t=-2.029, P=0.046]. The suture removal time and incidence of poor wound healing were also lower in the study group than in the control group, but the differences were not statistically significant (both P＞0.05). Conclusion: Early postoperative enteral nutrition support can effectively improve the nutritional status of breast cancer patients after neoadjuvant chemotherapy, enhance immune function to a certain extent, and promote postoperative recovery.
Clinical relevance
Breast cancer patients undergoing neoadjuvant therapy are at elevated risk for perioperative malnutrition and immunosuppression, yet standardized postoperative nutritional protocols in this population remain incompletely defined. This RCT addresses the gap between routine dietary counseling and targeted enteral supplementation using a tumor-specific oral medical formula in the immediate postoperative window. Given the expanding use of neoadjuvant regimens globally, optimizing perioperative nutritional support has direct implications for wound healing, immune reconstitution, and overall surgical recovery.
Key findings
1. Serum total protein was significantly higher in the enteral nutrition (study) group versus control at day 7 post-op: 72.42 ± 3.61 g/L vs 70.74 ± 3.76 g/L (t=2.040, P=0.045). 2. Serum albumin was significantly higher in the study group: 42.96 ± 2.20 g/L vs 42.02 ± 1.97 g/L (t=2.027, P=0.046). 3. CD3⁺ T lymphocyte percentage was significantly greater in the study group: 75.41% ± 7.72% vs 69.26% ± 8.55% (t=2.814, P=0.007). 4. CD8⁺ T lymphocyte percentage was significantly greater in the study group: 31.39% ± 9.43% vs 26.30% ± 6.89% (t=2.230, P=0.030). 5. Serum immunoglobulin levels (IgA, IgG, and IgM) were all significantly higher in the study group versus control (all P 0.05).
Practice implications
Clinicians managing breast cancer patients post-operatively following neoadjuvant therapy should consider initiating a tumor-specific oral enteral formula supplement on postoperative day 1, continuing through day 7, in addition to a standard high-protein, high-vitamin, low-fat diet targeting approximately 2,000 kcal/day. This strategy appears to yield measurable improvements in serum protein markers, T-cell and humoral immune parameters, and drain removal time, suggesting a clinically meaningful acceleration of postoperative recovery. Patient selection should prioritize those with pre-existing nutritional risk (assessed via NRS-2002) and immunosuppression from neoadjuvant chemotherapy, while noting that this single-center RCT of 90 patients warrants validation in larger, multicenter cohorts before broad guideline adoption.