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Meta-Analysis
. 2025 Apr;27(4):e70061.
doi: 10.1111/codi.70061.

The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: A systematic review and meta-analysis

Tyler McKechnie  1   2 , Tania Kazi  1 , Ghazal Jessani  3 , Victoria Shi  3 , Niv Sne  1   3 , Aristithes Doumouras  1   2   3 , Dennis Hong  1   3 , Cagla Eskicioglu  1   3
Affiliations
Meta-Analysis

The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: A systematic review and meta-analysis

Tyler McKechnie et al. Colorectal Dis. 2025 Apr.

Abstract

Aim: The present systematic review and meta-analysis aims to compare adult patients receiving enteral immunonutrition prior to elective colorectal surgery with those receiving conventional preoperative nutrition.

Methods: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from database inception to March 2024. Articles were included if they were randomized controlled trials or cohort studies evaluating adult patients undergoing elective colorectal surgery comparing preoperative enteral immunonutrition with conventional preoperative nutrition protocols. Main outcomes of interest included surgical site infection, anastomotic leak, overall postoperative morbidity and postoperative length of stay. An inverse variance random effects meta-analysis was performed. Risk of bias was assessed with Cochrane risk of bias assessment tools. The GRADE approach was conducted to assess quality of evidence.

Results: After reviewing 2508 relevant citations, 10 studies met inclusion criteria. Overall, 1521 patients (mean age 64.9 ± 10.0 years, 49.4% women) received preoperative immunonutrition and 1816 patients (mean age 64.1 ± 11.0 years, 52.1% women) received conventional preoperative nutrition. Across seven studies, there was a non-significant 30% relative risk reduction of surgical site infection (risk ratio 0.70, 95% CI 0.44-1.11, P = 0.13, I2 = 33%) and a non-significant 44% relative risk reduction of anastomotic leak (risk ratio 0.56, 95% CI 0.28-1.10, P = 0.09, I2 = 0%) in the immunonutrition group. Across eight studies, postoperative length of stay was 0.48 days shorter in the immunonutrition group (mean difference -0.48, 95% CI -0.84 to -0.12, P = 0.01, I2 = 53%). GRADE certainty of evidence was low or very low for all outcomes.

Conclusion: While point estimates suggest a likely benefit associated with preoperative enteral immunonutrition, wide corresponding 95% CIs suggest uncertainty remains. Further prospective study is warranted.

Keywords: colorectal cancer; colorectal surgery; immunonutrition; preoperative nutrition; systematic review.

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Conflict of interest statement

None of the authors have any potential conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
PRISMA diagram: transparent reporting of systematic reviews and meta‐analysis flow diagram outlining the search strategy results from initial search to included studies.
FIGURE 2
FIGURE 2
Forest plot of total postoperative complications results.
FIGURE 3
FIGURE 3
Forest plot of postoperative anastomotic leak results.
FIGURE 4
FIGURE 4
Forest plot of surgical site infection results.
FIGURE 5
FIGURE 5
Forest plot of postoperative genitourinary complication results.
FIGURE 6
FIGURE 6
Forest plot of postoperative mean LOS results.
FIGURE 7
FIGURE 7
Revised Cochrane risk‐of‐bias tool for randomized trials (RoB 2.0) results per individual randomized controlled trial.
FIGURE 8
FIGURE 8
Risk of Bias in Non‐randomized Studies of Interventions (ROBINS‐I) assessment tool results per individual observational cohort study.
See this image and copyright information in PMC

References

    1. Nelson G, Wang X, Nelson A, Faris P, Lagendyk L, Wasylak T, et al. Evaluation of the implementation of multiple enhanced recovery after surgery pathways across a provincial health care system in Alberta, Canada. JAMA Netw Open. 2021;4(8):e2119769. 10.1001/jamanetworkopen.2021.19769 - DOI - PMC - PubMed
    1. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long‐term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261(3):497–505. 10.1097/SLA.0000000000000854 - DOI - PubMed
    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. 10.3322/caac.21262 - DOI - PubMed
    1. Farooq A, Merath K, Hyer JM, Paredes AZ, Tsilimigras DI, Sahara K, et al. Financial toxicity risk among adult patients undergoing cancer surgery in the United States: an analysis of the National Inpatient Sample. J Surg Oncol. 2019;120(3):397–406. 10.1002/jso.25605 - DOI - PubMed
    1. Choi BY, Bae JH, Lee CS, Han SR, Lee YS, Lee IK. Implementation and improvement of enhanced recovery after surgery protocols for colorectal cancer surgery. Ann Surg Treat Res. 2022;102(4):223–233. 10.4174/astr.2022.102.4.223 - DOI - PMC - PubMed

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