Malnutrition is a common and potentially modifiable risk factor among patients undergoing gastrointestinal oncology surgery and is associated with increased postoperative complications, prolonged hospital stay, delayed functional recovery, impaired tolerance of adjuvant therapy, and hospital readmissions. Enhanced recovery after surgery (ERAS) pathways have transformed perioperative care by integrating evidence-based nutritional interventions with multimodal and multidisciplinary strategies to attenuate surgical stress and promote recovery. To summarize current evidence on perioperative nutritional and multidisciplinary care strategies that support recovery, reduce postoperative morbidity, and potentially contribute to the prevention of avoidable readmissions following gastrointestinal oncology surgery. A narrative review was conducted using PubMed/MEDLINE, EMBASE, Scopus, and Google Scholar to identify English-language literature published from January 2005 to June 2026, with the final search completed in July 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, consensus statements, and international clinical practice guidelines were considered. Evidence was synthesized narratively according to the perioperative continuum, including nutritional assessment and optimization, prehabilitation, intraoperative management, postoperative nutritional care, multidisciplinary recovery, transitional care, procedure-specific considerations, implementation challenges, and emerging technologies. Early nutritional screening, individualized nutritional optimization, and multimodal prehabilitation may improve physiological reserve before surgery. Within ERAS pathways, carbohydrate loading, minimally invasive surgery, goal-directed fluid therapy, multimodal analgesia, early mobilization, and early oral feeding support recovery and may reduce postoperative morbidity. Postoperative nutritional care emphasizes early oral or enteral feeding, oral nutritional supplements, selective parenteral nutrition, and serial monitoring to achieve nutritional adequacy. Structured multidisciplinary care and transitional follow-up may improve continuity, nutritional recovery, and treatment readiness, although direct evidence for an independent reduction in 30-day readmissions remains limited. Procedure-specific nutritional management is important after esophageal, gastric, pancreatic, hepatic, and colorectal resections. Perioperative nutritional care should be regarded as a continuous process extending from preoperative assessment through post-discharge follow-up. Evidence-based nutritional strategies within ERAS pathways and multidisciplinary care can improve postoperative recovery and reduce complications. Transitional nutritional support may help identify and address factors associated with avoidable readmission, although its independent effect on 30-day readmission requires further study. Future research should focus on procedure-specific pathways, precision nutrition, digital monitoring, and adequately powered clinical trials using standardized clinical, functional, nutritional, and readmission outcomes.
Core Tip: Early nutritional assessment, individualized nutritional optimization, and multidisciplinary care within enhanced recovery after surgery pathways can improve recovery and reduce postoperative complications after gastrointestinal oncology surgery. These strategies may also help address modifiable contributors to readmission, although direct evidence for an independent reduction in 30-day readmissions remains limited. Procedure-specific pathways, digital monitoring, and precision nutrition represent important areas for further research.
