Perioperative Immunonutrition in Gastrointestinal Oncology: A Comprehensive Umbrella Review and Meta-Analysis on Behalf of TROGSS-The Robotic Global Surgical Society.

INTRODUCTION

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.

METHODS

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).

RESULTS

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%).

CONCLUSIONS

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.