Perioperative nutrition and multidisciplinary care in gastrointestinal oncology surgery: Evidence-based strategies to enhance recovery and inform readmission prevention

Table 2 Landmark studies on perioperative nutrition in gastrointestinal oncology surgery

Ref.	Study design	Population	Intervention	Primary outcome (s)	Effect estimate	Limitations	Key clinical message
Braga et al[37], 1999	Prospective, randomized, double-blind phase III RCT	206 patients undergoing colorectal, gastric, or pancreatic cancer surgery	Perioperative immunonutrition containing arginine, RNA, and ω-3 fatty acids vs standard enteral formula	Postoperative infectious complications; hospital stay	Infections: 14% vs 30% (P = 0.009); hospital stay: 11.1 days vs 12.9 days (P = 0.01)	Single immunonutrition formulation; mortality was not significantly different	Perioperative immunonutrition reduced postoperative infectious complications and hospital stay
Gianotti et al[38], 2002	Prospective randomized controlled trial	305 patients undergoing gastrointestinal cancer surgery	5 days of preoperative immunonutrition vs the same preoperative treatment plus postoperative jejunal immunonutrition vs conventional care	Postoperative infections; hospital stay	Infections: 13.7% vs 15.8% vs 30.4%; hospital stay: 11.6 days vs 12.2 days vs 14.0 days	Included patients with < 10% preoperative weight loss; applicability to severely malnourished patients are uncertain	Five days of preoperative immunonutrition produced outcomes comparable to perioperative administration and was superior to conventional care for infectious morbidity and hospital stay
Lassen et al[39], 2008	Multicentre randomized controlled trial	447 patients undergoing major upper gastrointestinal surgery	Early oral feeding vs nil-by-mouth strategy with jejunostomy feeding	Major complications; bowel recovery; hospital stay	No increase in anastomotic complications; earlier recovery and shorter hospital stay	Open-label design; limited to upper gastrointestinal surgery	Early oral feeding can be safely implemented after major upper gastrointestinal surgery in appropriately selected patients and supports ERAS-based recovery
Lewis et al[40], 2009	Systematic review and meta-analysis of 13 RCTs; 1173 patients	Patients undergoing gastrointestinal surgery	Early enteral nutrition (< 24 hours) vs delayed feeding	Mortality; complications; hospital stay	Lower mortality and shorter hospital stay; trend toward fewer complications	Heterogeneity in surgical procedures and feeding protocols	Early enteral nutrition should be initiated when clinically feasible after gastrointestinal surgery
Weimann et al[41], 2025	ESPEN Clinical Practice Guideline	Adult patients undergoing elective and emergency surgery	Evidence-based perioperative nutritional recommendations	Guideline recommendations	Not applicable	Guideline based on synthesis of available evidence rather than a primary clinical study	Nutritional screening, timely nutritional therapy, and integration of nutritional care within ERAS are recommended components of perioperative management

Table 2 summarizes pivotal evidence that has influenced contemporary perioperative nutritional management in gastrointestinal surgery. The selected studies include landmark trials of immunonutrition and early feeding together with current guideline-based recommendations. Effect estimates are reported as provided in the cited studies; they should be interpreted in the context of differences in patient selection, surgical procedures, nutritional protocols, and outcome definitions. ERAS: Enhanced recovery after surgery; RCT: Randomized controlled trial; ω-3: Omega-3 fatty acids; ESPEN: European Society for Clinical Nutrition and Metabolism.