{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:49:48Z","timestamp":1791906588027,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as a potential strategy to improve surgical outcomes by reducing complications, enhancing immune function, and promoting recovery. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted on 28 October 2024 in accordance with PRISMA guidelines. Systematic reviews and meta-analyses evaluating perioperative IMN versus standard care in adult patients undergoing GI cancer surgery were included in the search. The outcomes assessed included infectious and non-infectious complications, wound healing, hospital stay, and nutritional status. The study quality was evaluated using AMSTAR 2, and the meta-analysis was conducted using random-effects models to calculate the pooled effect sizes (risk ratios [RRs], odds ratios [ORs], mean differences [MDs]) with 95% confidence intervals (CIs). Results: Sixteen systematic reviews and meta-analyses, including a total of 41,072 patients, were included. IMN significantly reduced infectious complications (RR: 0.62, 95% CI: 0.55\u20130.70; I2 = 63.0%), including urinary tract infections (RR: 0.74, 95% CI: 0.61\u20130.89; I2 = 0.0%) and wound infections (OR: 0.64, 95% CI: 0.55\u20130.73; I2 = 34.4%). Anastomotic leak rates were notably lower (RR: 0.68, 95% CI: 0.62\u20130.75; I2 = 8.2%). While no significant reduction in pneumonia risk was observed, non-infectious complications decreased significantly (RR: 0.83, 95% CI: 0.75\u20130.92; I2 = 30.6%). IMN also reduced the length of hospital stay by an average of 1.92 days (MD: \u22121.92, 95% CI: \u22122.36 to \u22121.48; I2 = 73.5%). Conclusions: IMN provides significant benefits in GI cancer surgery, reducing complications and improving recovery. However, variability in protocols and populations highlight the need for standardization and further high-quality trials to optimize its application and to validate its efficacy in enhancing surgical care.<\/jats:p>","DOI":"10.3390\/nu17142304","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T07:54:23Z","timestamp":1752479663000},"page":"2304","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Perioperative Immunonutrition in Gastrointestinal Oncology: A Comprehensive Umbrella Review and Meta-Analysis on Behalf of TROGSS\u2014The Robotic Global Surgical Society"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7336-1366","authenticated-orcid":false,"given":"Aman","family":"Goyal","sequence":"first","affiliation":[{"name":"Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India"},{"name":"Department of Surgery, Adesh Institute of Medical Sciences and Research, Bathinda 151001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0481-8187","authenticated-orcid":false,"given":"Christian Adrian","family":"Macias","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil 090615, Ecuador"},{"name":"Department of Health and Sciences, Hillsborough Community College, Tampa, FL 33614, USA"},{"name":"Center for Space Emerging Technologies, Lima 15046, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paula","family":"Corzo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universidad de Los Andes, Bogota 111711, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6863-5300","authenticated-orcid":false,"given":"Vanessa Pamela Salolin","family":"Vargas","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Westhill, Mexico City 05610, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8866-886X","authenticated-orcid":false,"given":"Mathew","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX 77001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-5581","authenticated-orcid":false,"given":"Jes\u00fas Enrique","family":"Guarecuco Castillo","sequence":"additional","affiliation":[{"name":"Larkin Community Hospital, South Miami, FL 33431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5301-7556","authenticated-orcid":false,"given":"Andrea","family":"Garcia","sequence":"additional","affiliation":[{"name":"Unidsad de Investigaci\u00f3n Biom\u00e9dica 02, Hospital de Especialidades del Centro M\u00e9dico Nacional de Occidente, Guadalajara 44349, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathia Dayana","family":"Morfin-Meza","sequence":"additional","affiliation":[{"name":"Unidsad de Investigaci\u00f3n Biom\u00e9dica 02, Hospital de Especialidades del Centro M\u00e9dico Nacional de Occidente, Guadalajara 44349, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6230-8359","authenticated-orcid":false,"given":"Clotilde","family":"Fuentes-Orozco","sequence":"additional","affiliation":[{"name":"Unidsad de Investigaci\u00f3n Biom\u00e9dica 02, Hospital de Especialidades del Centro M\u00e9dico Nacional de Occidente, Guadalajara 44349, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Gonz\u00e1lez-Ojeda","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Osvaldo","family":"Su\u00e1rez-Carre\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Bariatric Surgery, UMAE Hospital de Especialidades del Centro Medico Nacional de Occidente, Guadalajara 44349, Mexico"},{"name":"Department of Surgery, Universidad de Guadalajara, Guadalajara 44340, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4303-7714","authenticated-orcid":false,"given":"Elena","family":"Ruiz-\u00dacar","sequence":"additional","affiliation":[{"name":"Fuenlabrada Universitary Hospital, Rey Juan Carlos University, 28943 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2030-6712","authenticated-orcid":false,"given":"Yogesh","family":"Vashist","sequence":"additional","affiliation":[{"name":"Department of Surgery, Organ Transplant Center for Excellence, Center for Liver Diseases and Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 12271, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo","family":"P\u00e9rez Bonet","sequence":"additional","affiliation":[{"name":"Department of Surgery, Clinica Gloria Patricia Pinz\u00f3n Clinic, Florencia 180001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3408-4540","authenticated-orcid":false,"given":"Adel","family":"Abou-Mrad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centre Hospitalier Universitaire d\u2019Orl\u00e9ans, 45000 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3784-6555","authenticated-orcid":false,"given":"Rodolfo J.","family":"Oviedo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX 77001, USA"},{"name":"Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX 75962, USA"},{"name":"Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-9588","authenticated-orcid":false,"given":"Luigi","family":"Marano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS: Akademia Medycznych i Spolecznych Nauk Stosowanych, 52-300 Elbl\u0105g, Poland"},{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, 80-000 Gda\u0144sk, Poland"},{"name":"Department of Surgery, Dnipro State Medical University, 49044 Dnipro, Ukraine"},{"name":"Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"ref_1","first-page":"395","article-title":"Mapping the Landscape of Immunonutrition and Cancer Research: A Comprehensive Bibliometric Analysis on Behalf of NutriOnc Research Group","volume":"110","author":"Cattaneo","year":"2024","journal-title":"Int. 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