Immunonutrition in surgical patients with colorectal cancer: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported at review level

• Effect Size: Not quantified — narrative synthesis only; directional finding of reduced wound infections with combined immunonutrition (arginine, omega-3 fatty acids, nucleotides, L-alanine, L-glutamine); no benefit identified with isolated supplementation

• Primary Outcome: Postoperative complications in colorectal cancer surgical patients receiving immunonutrient supplementation

• Nnt Or Sensitivity: Not calculable from available data — no pooled event rates or risk ratios provided; NNT cannot be derived from this narrative synthesis

• Confidence Interval: Not reported — no meta-analysis performed

Clinical Application

Combined immunonutrition formulas (e.g., IMPACT, Oral Impact) are commercially available and can be administered preoperatively (5–7 days), postoperatively, or perioperatively. Feasibility is generally high in elective surgical settings with adequate dietetic support. Cost and patient adherence to preoperative oral supplementation remain practical considerations. In Australia, perioperative immunonutrition for colorectal cancer surgery aligns with ESPEN 2021 guidelines on clinical nutrition in surgery, which are referenced by Australian surgical and dietetic practice. The Dietitians Australia and RACGP support nutritional optimisation in surgical oncology patients. Immunonutrition formulas such as IMPACT are available in Australia but are not currently listed on the PBS, meaning cost is borne by patients or institutions. The TGA does not regulate these products as therapeutic goods in the same category as pharmaceuticals. Australian Enhanced Recovery After Surgery (ERAS) protocols for colorectal surgery increasingly incorporate preoperative nutritional optimisation, and this review's findings are broadly consistent with that framework, though the lack of quantified effect sizes limits direct guideline translation. Clinicians should refer to the ERAS Society and ESPEN guidelines for specific dosing and timing recommendations pending higher-certainty Australian-specific evidence. Adult patients with colorectal cancer undergoing elective surgical resection, particularly those at nutritional risk. Applicability to emergency surgery, advanced/metastatic disease, or patients receiving concurrent neoadjuvant chemoradiotherapy requires further evidence.

Abstract

Introduction: surgery in patients with colorectal cancer often leads to complications, affecting recovery, prolonging hospital stay, and impacting quality of life. Immunonutrition plays an important role by modulating the immune system and may contribute to the reduction of these complications. Objective: to assess the effect of immunonutrient supplementation on complications in surgical patients with colorectal cancer. Materials and methods: a literature search was conducted in PubMed, Web of Science, Embase, and Cochrane, following the PRISMA model. A total of 20 clinical trials and two observational studies published between 2000 and 2025 were selected, analyzing postoperative complications, physical or nutritional status, immune response, and length of hospital stay. Results: a reduction in postoperative complications was observed with combined immunonutrient supplementation (arginine, omega-3 fatty acids, nucleotides, L-alanine, and L-glutamine), particularly in wound infections. No benefits were found with isolated supplementation. Conclusion: combined immunonutrient administration may improve postoperative complications, especially wound infections, although results regarding hospital stay are inconsistent. Isolated supplementation with omega-3 fatty acids shows no benefit. Introducción: la cirugía en pacientes con cáncer colorrectal conlleva complicaciones, alterando la recuperación, alargando la estancia hospitalaria y afectando a la calidad de vida. La inmunonutrición ejerce una acción importante al modular el sistema inmunológico y podría mejorar estas complicaciones. Objetivo: evaluar el efecto de la suplementación con inmunonutrientes en las complicaciones en pacientes quirúrgicos por cáncer colorrectal. Material y métodos: se realizó una búsqueda bibliográfica en PubMed, Web of Science, Embase y Cochrane, siguiendo el modelo PRISMA. Se seleccionaron 20 ensayos clínicos y dos observaciones, publicados entre 2000 y 2025, que analizaron complicaciones posoperatorias, el estado físico o nutricional, la respuesta inmune y la duración de estancia hospitalaria. Resultados: se halló una reducción de las complicaciones posoperatorias con una suplementación combinada de inmunonutrientes como arginina, ácidos grasos omega-3, nucleótidos, L-alanina y L-glutamina, especialmente en infecciones de herida, sin beneficios en la administración aislada. Conclusión: la administración combinada podría mejorar las complicaciones posquirúrgicas, especialmente de la infección de la herida, con resultados contradictorios para estancia hospitalaria. La suplementación aislada de ácidos grasos n-3 no aporta beneficios.

References

1. 1.Rodríguez-Criado, C., Gavilán-Díaz, R., & Cabañas Alite, L. (2026). Immunonutrition in surgical patients with colorectal cancer: a systematic review. Nutricion Hospitalaria. https://doi.org/10.20960/nh.06378