Preoperative Immunonutrition and Postoperative Infectious Complications Following Major Gastrointestinal Surgery
Preoperative Immunonutrition and Infectious Outcomes
DOI:
https://doi.org/10.69750/dmls.03.05.0209Keywords:
Immunonutrition, gastrointestinal surgery, postoperative infection, surgical-site infection, nutritional supportAbstract
Background: Infection is a common cause of morbidity following major gastrointestinal surgery. The potential benefits of immunonutrition in local surgical populations are unclear, although immunonutrition may boost immune competence and tissue recovery before surgery.
Objective: To assess the relationship between immunonutrition before surgery and postoperative infectious complications after major gastrointestinal surgery.
Methods: The study was a prospective comparative cohort study performed at the Department of Surgery, Khyber Medical University Institute of Medical Sciences, DHQ Teaching Hospital, KDA Kohat, from February 2025 to January 2026. Seventy adult patients scheduled for elective major gastrointestinal surgery were randomly assigned to either the immunonutrition group or the standard-care group, with each group including 35 individuals. The immunonutrition group received an oral formula of arginine, omega-3 fatty acids, and nucleotides for 7 days before surgery. The main outcome was the incidence of any infectious complication within 30 days. Independent associations were analyzed using multivariable logistic regression.
Results: Infectious complications occurred in 5 (14.3%) patients receiving immunonutrition and 14 (40.0%) controls (p=0.016). There was no difference between the two groups in terms of surgical-site infection rate (5.7% vs. 25.7%, p=0.045). Overall postoperative complications were also reduced (25.7% versus 51.4%; p=0.049), and mean hospital stay was shorter (8.3±2.9 versus 10.7±4.1 days; p=0.006). Preoperative immunonutrition was still an independent risk factor for reducing risk of infection (adjusted odds ratio 0.23, 95% confidence interval 0.06–0.84; p=0.026).
Conclusion: Preoperative immunonutrition was associated with fewer postoperative infections, reduced overall morbidity, and shorter hospitalization after major gastrointestinal surgery. These results suggest that nutritional optimization during the perioperative period is important in patients who undergo the right kind of surgery.
Downloads
References
Budai BC, Panait R, Laczkó B, Cai G, Váncsa S, Veres DS, et al. Immunonutrition decreases postoperative complications in gastrointestinal cancer: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2026;100690. doi:10.1016/j.advnut.2026.100690.
Weimann A, Bezmarevic M, Braga M, Correia MITD, Funk-Debleds P, Gianotti L, et al. ESPEN guideline on clinical nutrition in surgery—update 2025. Clin Nutr. 2025;53:222-261. doi:10.1016/j.clnu.2025.08.029.
Goyal A, Macias CA, Corzo MP, Salolin Vargas VP, Mendoza M, Guarecuco Castillo JE, et al. Perioperative immunonutrition in gastrointestinal oncology: a comprehensive umbrella review and meta-analysis on behalf of TROGSS—The Robotic Global Surgical Society. Nutrients. 2025;17(14):2304. doi:10.3390/nu17142304.
McKechnie T, Kazi T, Jessani G, Shi V, Sne N, Doumouras A, et al. The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: a systematic review and meta-analysis. Colorectal Dis. 2025;27(4):e70061. doi:10.1111/codi.70061.
Wong CS, Zaman S, Siddiraju K, Sellvaraj A, Ghattas T, Tryliskyy Y. Effects of enteral immunonutrition in laparoscopic versus open resections in colorectal cancer surgery: a meta-analysis of randomised controlled trials. Eur J Surg Oncol. 2025;51(2):109488. doi:10.1016/j.ejso.2024.109488.
Pannirselvam M, Zakaria Z, Wong MPK, Abdul Satar MHS, Jusoh NS, Zakaria AD, et al. Effects of preoperative immunonutrition versus standard oral nutrition in patients undergoing colorectal surgery: a randomized controlled trial. World J Gastrointest Surg. 2025;17(9):108127. doi:10.4240/wjgs.v17.i9.108127.
Gustafsson UO, Rockall TA, Wexner S, How KY, Emile S, Marchuk A, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery Society recommendations 2025. Surgery. 2025;184:109397. doi:10.1016/j.surg.2025.109397.
Matsui R, Sagawa M, Sano A, Sakai M, Hiraoka S, Tabei I, et al. Impact of perioperative immunonutrition on postoperative outcomes for patients undergoing head and neck or gastrointestinal cancer surgeries: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2024;279(3):419-428. doi:10.1097/SLA.0000000000006116.
Yu J, Yuan A, Liu Q, Wang W, Sun Y, Li Z, et al. Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial. World J Surg Oncol. 2024;22(1):101. doi:10.1186/s12957-024-03348-y.
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(5):577. doi:10.3390/nu16050577.
Ural B, Yılmaz-Akyüz E, Akyüz C. Impact of immunonutrition on nutritional status in patients undergoing colorectal cancer surgery: a randomized controlled clinical trial. Nutr Cancer. 2024;76(6):469-475. doi:10.1080/01635581.2024.2338607.
Zou Q, Yin Z, Ding L, Ruan J, Zhao G, Wang X, et al. Effect of preoperative oral nutritional supplements on clinical outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2024;103(39):e39844. doi:10.1097/MD.0000000000039844.
Karanikki E, Frountzas M, Lidoriki I, Kozadinos A, Mylonakis A, Tsikrikou I, et al. The predictive role of preoperative malnutrition assessment in postoperative outcomes of patients undergoing surgery due to gastrointestinal cancer: a cross-sectional observational study. J Clin Med. 2024;13(23):7479. doi:10.3390/jcm13237479.
Ma M, Zheng Z, Zeng Z, Li J, Ye X, Kang W. Perioperative enteral immunonutrition support for the immune function and intestinal mucosal barrier in gastric cancer patients undergoing gastrectomy: a prospective randomized controlled study. Nutrients. 2023;15(21):4566. doi:10.3390/nu15214566.
Ricci C, Serbassi F, Alberici L, Ingaldi C, Gaetani L, De Raffele E, et al. Immunonutrition in patients who underwent major abdominal surgery: a comprehensive systematic review and component network meta-analysis using GRADE and CINeMA approaches. Surgery. 2023;174(6):1401-1409. doi:10.1016/j.surg.2023.08.005.
Fan Y, Li N, Zhang J, Fu Q, Qiu Y, Chen Y. The effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis. BMC Cancer. 2023;23(1):351. doi:10.1186/s12885-023-10820-7.
Zhou Y, Li TT, Yang ZL, Tan ZM, Yang CF, Wang Z. The effect of perioperative immunonutrition on patients undergoing esophagectomy: a systematic review and updated meta-analysis. Nutr Hosp. 2023;40(4):839-847. doi:10.20960/nh.04371.
Lee SY, Lee J, Park HM, Kim CH, Kim HR. Impact of preoperative immunonutrition on the outcomes of colon cancer surgery: results from a randomized controlled trial. Ann Surg. 2023;277(3):381-386. doi:10.1097/SLA.0000000000005140.
Cadili L, van Dijk PAD, Grudzinski AL, Cape J, Kuhnen AH. The effect of preoperative oral nutritional supplementation on surgical-site infections among adult patients undergoing elective surgery: a systematic review and meta-analysis. Am J Surg. 2023;226(3):330-339. doi:10.1016/j.amjsurg.2023.06.011.
Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, et al. Guidelines for perioperative care in elective abdominal and pelvic surgery at primary and secondary hospitals in low- and middle-income countries: Enhanced Recovery After Surgery Society recommendation. World J Surg. 2022;46(8):1826-1843. doi:10.1007/s00268-022-06587-w.
Knight SR, Qureshi AU, Drake TM, Lapitan MCM, Maimbo M, Yenli E, et al. The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis. Sci Rep. 2022;12(1):12456. doi:10.1038/s41598-022-16460-4.
Roulin D, Demartines N. Principles of enhanced recovery in gastrointestinal surgery. Langenbecks Arch Surg. 2022;407(7):2619-2627. doi:10.1007/s00423-022-02602-9.
Niu JW, Zhou L, Liu ZZ, Pei DP, Fan WQ, Ning W. A systematic review and meta-analysis of the effects of perioperative immunonutrition in gastrointestinal cancer patients. Nutr Cancer. 2021;73(2):252-261. doi:10.1080/01635581.2020.1749291.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761. doi:10.1016/j.clnu.2021.03.031.
Li XK, Cong ZZ, Wu WJ, Xu Y, Zhou H, Wang GM, et al. Enteral immunonutrition versus enteral nutrition for patients undergoing esophagectomy: a randomized controlled trial. Ann Palliat Med. 2021;10(2):1351-1361. doi:10.21037/apm-20-1399.
Downloads
PlumX Metrics
Published
Issue
Section
License
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third-party material in this article are included in the article’s Creative Commons license unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you must obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
How to Cite
