To systematically evaluate the efficacy and safety of perioperative enteral nutrition (EN) in patients with primary liver cancer (PLC) undergoing hepatectomy.

Studies related to perioperative EN in PLC patients undergoing hepatectomy were retrieved from China Biomedical Literature Service System (CBM), Wanfang Data, CNKI, Chongqing VIP, PubMed, Cochrane Library, Web of Science and Embase databases from the database inception to June 2022. The searching words included hepatectomy, liver resection, partial hepatectomy, liver neoplasms, perioperative nutrition, enteral feeding and postoperative nutrition in both Chinese and English. The main outcome indexes were postoperative ALB, liver function and gastrointestinal function recovery, etc. Meta-analysis was carried out by RevMan 5.4 software.

16 RCTs consisting of 1 390 patients were finally included. Meta-analysis showed that compared with routine nutrition or intravenous nutrition support, perioperative EN increased postoperative ALB level (MD=2.22, 95%CI: 0.96-3.49, P<0.05) and decreased ALT level (MD=-9.45, 95%CI: -17.71--1.20, P<0.05) and TB level (MD=-3.92, 95%CI: -5.37--2.11, P<0.05), shorten the first postoperative exhaust time (SMD=-1.42, 95%CI: -1.95--0.90, P<0.05), the defecation time (SMD=-1.46, 95%CI: -2.12--0.81, P<0.05) and the length of postoperative hospital stay (MD=-2.28, 95%CI: -3.04--1.52, P<0.05), and reduce the incidence of postoperative gastrointestinal discomfort (OR=0.35, 95%CI: 0.22-0.57, P<0.05).

Compared with routine nutrition, perioperative EN can improve the nutritional status, promote the recovery of postoperative liver and gastrointestinal function, reduce the incidence of postoperative gastrointestinal adverse reactions, shorten the length of postoperative hospital stay and accelerate postoperative rehabilitation of PLC patients.