Impact of Perioperative Immunonutrition on Postoperative Outcomes in Patients with Upper Gastrointestinal Cancer - A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sep 21, 2026

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There is no consensus on the efficacy of perioperative immunonutrition in patients undergoing upper gastrointestinal (GI) cancer surgery. This systematic review and meta-analysis clarified its impact on postoperative outcomes by searching MEDLINE (PubMed and OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Emcare from 1981–2022 and including randomized controlled trials. Immunonutrition (arginine, n-3 omega fatty acids, or glutamine) was compared with standard nutritional therapy. Immunonutrition reduced infectious complications within 30 days after surgery (relative risk 0.72; 95% CI 0.57–0.92; moderate certainty).

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages55

Reading Time2 h 19 min

AccessFree to download

Abstract

Introduction

Materials and Methods

Eligibility and outcomes (per the abstracted methods)

Results

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Conclusions

nutrients Systematic Review Impact of Perioperative Immunonutrition on Postoperative Outcomes in Patients with Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Ryota Matsui 1,2,3, Masano Sagawa 4, Noriyuki Inaki 3, Tetsu Fukunaga 2 and Souya Nunobe 1, * Citation: Matsui, R.; Sagawa, M.; Inaki, N.; Fukunaga, T.; Nunobe, S. Impact of Perioperative Immunonutrition on Postoperative Outcomes in Patients with Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2024, 16, 577. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)nu16050577 Academic Editor: Debasis Bagchi Received: 30 December 2023 Revised: 8 February 2024 Accepted: 17 February 2024 Published: 20 February 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; [supreme0818@gmail.com](supreme0818@gmail.com) 2 Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan; [t2fukunaga@juntendo.ac.jp](t2fukunaga@juntendo.ac.jp) 3 Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8530, Japan 4 Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo 123-8558, Japan; [masanosagawa@yahoo.co.jp](masanosagawa@yahoo.co.jp) * Correspondence: [souya.nunobe@jfcr.or.jp](souya.nunobe@jfcr.or.jp) Abstract: There is no consensus on the efﬁcacy of perioperative immunonutrition in patients with upper gastrointestinal (GI) cancer surgery. We clariﬁed the impact of perioperative immunonutrition on postoperative outcomes in patients with upper GI cancers. We searched MEDLINE (PubMed), MEDLINE (OVID), EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Selection, and Emcare from 1981–2022 using search terms related to immunonutrition and upper GI cancer. We included randomized controlled trials. Intervention was deﬁned as immunonutritional therapy, including arginine, n-3 omega fatty acids, or glutamine during the perioperative period. The control was deﬁned as standard nutritional therapy. The primary outcomes were infectious complications, deﬁned as events with a Clavien–Dindo classiﬁcation grade 􀀕 II that occurred within 30 days after surgery. After screening, 23 studies were included in the qualitative synthesis and in the quantitative synthesis. The meta-analysis showed that immunonutrition reduced infectious complications (relative risk ratio: 0.72; 95% conﬁdence interval: 0.57–0.92; certainty of evidence: Moderate) compared with standard nutritional therapy. In conclusion, nutritional intervention with perioperative immunonutrition in patients with upper GI cancers signiﬁcantly reduced infectious complications. The effect of immunonutrition for upper GI cancers in reducing the risk of infectious complications was about 30% . Keywords: gastrointestinal cancer; immunonutrition; nutritional intervention; perioperative nutrition 1. Introduction For cancer patients, surgical resection is the main treatment, and one of the risk factors for problems after surgery is preoperative malnutrition [1,2] . Patients with gastrointestinal cancers often have worsened nutritional status, which ranges from 20–70%[3,4] . The immune system and tissue repair are impacted by malnutrition [3] . Furthermore, the surgical invasion-induced catabolic processes result in the loss of vital nutrients, which might induce immune response d

FAQs

What was the main goal of this systematic review and meta-analysis?

To clarify the effectiveness of perioperative immunonutrition on postoperative outcomes in patients undergoing elective surgery for upper GI cancer, focusing on infectious complications.

How were the intervention and control defined in the included randomized controlled trials?

Intervention was immunonutritional therapy during the perioperative period, including arginine, n-3 omega fatty acids, or glutamine; control was standard nutritional therapy.

What were the primary outcomes, and what did the meta-analysis find?

Primary outcomes were infectious complications occurring within 30 days after surgery (Clavien–Dindo grade > II). Immunonutrition reduced infectious complications versus standard nutrition (relative risk 0.72; 95% CI 0.57–0.92).

Sep 21, 2026

Uploaded by Finn