Goyal Aman, Macias Christian Adrian, Corzo Maria Paula, Vargas Vanessa Pamela Salolin, Mendoza Mathew, Guarecuco Castillo Jesús Enrique, Garcia Andrea, Morfin-Meza Kathia Dayana, Fuentes-Orozco Clotilde, González-Ojeda Alejandro, Suárez-Carreón Luis Osvaldo, Ruiz-Úcar Elena, Vashist Yogesh, Pérez Bonet Adolfo, Abou-Mrad Adel, Oviedo Rodolfo J, Marano Luigi
Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India.
Department of Surgery, Adesh Institute of Medical Sciences and Research, Bathinda 151001, India.
Nutrients. 2025 Jul 13;17(14):2304. doi: 10.3390/nu17142304.
Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as a potential strategy to improve surgical outcomes by reducing complications, enhancing immune function, and promoting recovery.
A systematic search of PubMed, Scopus, and the Cochrane Library was conducted on 28 October 2024 in accordance with PRISMA guidelines. Systematic reviews and meta-analyses evaluating perioperative IMN versus standard care in adult patients undergoing GI cancer surgery were included in the search. The outcomes assessed included infectious and non-infectious complications, wound healing, hospital stay, and nutritional status. The study quality was evaluated using AMSTAR 2, and the meta-analysis was conducted using random-effects models to calculate the pooled effect sizes (risk ratios [RRs], odds ratios [ORs], mean differences [MDs]) with 95% confidence intervals (CIs).
Sixteen systematic reviews and meta-analyses, including a total of 41,072 patients, were included. IMN significantly reduced infectious complications (RR: 0.62, 95% CI: 0.55-0.70; = 63.0%), including urinary tract infections (RR: 0.74, 95% CI: 0.61-0.89; = 0.0%) and wound infections (OR: 0.64, 95% CI: 0.55-0.73; = 34.4%). Anastomotic leak rates were notably lower (RR: 0.68, 95% CI: 0.62-0.75; = 8.2%). While no significant reduction in pneumonia risk was observed, non-infectious complications decreased significantly (RR: 0.83, 95% CI: 0.75-0.92; = 30.6%). IMN also reduced the length of hospital stay by an average of 1.92 days (MD: -1.92, 95% CI: -2.36 to -1.48; = 73.5%).
IMN provides significant benefits in GI cancer surgery, reducing complications and improving recovery. However, variability in protocols and populations highlight the need for standardization and further high-quality trials to optimize its application and to validate its efficacy in enhancing surgical care.
胃肠道（GI）癌症与高发病率和高死亡率相关。手术切除作为主要治疗方法，常常会引发免疫抑制并增加术后并发症的风险。围手术期免疫营养（IMN），包括富含ω-3脂肪酸、精氨酸、核苷酸和抗氧化剂的制剂，已成为一种潜在策略，可通过减少并发症、增强免疫功能和促进恢复来改善手术效果。
于2024年10月28日按照PRISMA指南对PubMed、Scopus和Cochrane图书馆进行了系统检索。检索纳入了评估接受胃肠道癌症手术的成年患者围手术期IMN与标准护理的系统评价和荟萃分析。评估的结局包括感染性和非感染性并发症、伤口愈合、住院时间和营养状况。使用AMSTAR 2评估研究质量，并使用随机效应模型进行荟萃分析，以计算合并效应量（风险比[RRs]、优势比[ORs]、平均差[MDs]）及95%置信区间（CIs）。
纳入了16项系统评价和荟萃分析，共涉及41,072例患者。IMN显著降低了感染性并发症（RR：0.62，95% CI：0.55 - 0.70；I² = 63.0%），包括尿路感染（RR：0.74，95% CI：0.61 - 0.89；I² = 0.0%）和伤口感染（OR：0.64，95% CI：0.55 - 0.73；I² = 34.4%）。吻合口漏发生率显著更低（RR：0.68，95% CI：0.62 - 0.75；I² = 8.2%）。虽然未观察到肺炎风险显著降低，但非感染性并发症显著减少（RR：0.83，95% CI：0.75 - 0.92；I² = 30.6%）。IMN还使平均住院时间缩短了1.92天（MD： - 1.92，95% CI： - 2.36至 - 1.48；I² = 73.5%）。
IMN在胃肠道癌症手术中具有显著益处，可减少并发症并改善恢复情况。然而，方案和人群的变异性凸显了标准化和进一步高质量试验的必要性，以优化其应用并验证其在增强手术护理方面的疗效。
