{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:28:40Z","timestamp":1787300920595,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"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>A standardized extract of cultured Lentinula edodes mycelia (ECLM), commercially known as AHCC\u00ae, shows anti-inflammatory, immunomodulatory, and organ-protective properties. Experimental studies have indicated that ECLM modulates innate and adaptive immunity, including natural killer (NK) cell activity, antigen-presenting cell function, T-cell responses, and cytokine balance. These effects are particularly relevant in oncology because surgical stress and ischemia\u2013reperfusion injury (IRI) generate a transient perioperative environment characterized by immune suppression, inflammation, and conditions favorable for metastatic progression. Recent animal studies have demonstrated the protective effects of ECLM in intestinal and hepatic IRI models, providing a potential mechanistic rationale for improving the perioperative host microenvironment. Clinical studies on hepatocellular carcinoma, pancreatic cancer, and gynecological malignancies suggest that ECLM may offer potential benefits in immune preservation, nutritional support, symptom management, and recurrence prevention, although most studies are small and hypothesis-generating. Emerging evidence from patient-derived xenograft and spontaneous carcinogenesis models further suggests that ECLM may influence tumor biology beyond host immune activation, although the underlying mechanisms require elucidation. This review summarizes the mechanistic, preclinical, translational, and clinical evidence supporting the use of ECLM as a candidate for perioperative immunonutritional strategies. We propose the hypothesis that ECLM may function as a perioperative microenvironmental stabilizer that integrates immune preservation and intestinal barrier protection.<\/jats:p>","DOI":"10.3390\/nu18162731","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"2731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunomodulatory and Immunonutritional Effects of a Standardized Extract of Cultured Lentinula\u00a0edodes Mycelia in Cancer: From Prevention to Perioperative Microenvironment Stabilization"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7909-9570","authenticated-orcid":false,"given":"Richi","family":"Nakatake","sequence":"first","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Osaka, Japan"},{"name":"Department of Pancreatobiliary Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5149-5731","authenticated-orcid":false,"given":"Tetsuya","family":"Okuyama","sequence":"additional","affiliation":[{"name":"Department of Pancreatobiliary Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9876-3086","authenticated-orcid":false,"given":"Toru","family":"Matsu-ura","sequence":"additional","affiliation":[{"name":"Department of Pathology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Kitade","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Osaka, Japan"},{"name":"Department of Pancreatobiliary Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1117-2807","authenticated-orcid":false,"given":"Mikio","family":"Nishizawa","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences, Ritsumeikan University, Kusatsu 525-8577, Shiga, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","article-title":"Hallmarks of cancer: The next generation","volume":"144","author":"Hanahan","year":"2011","journal-title":"Cell"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/nrclinonc.2014.224","article-title":"Exploiting the critical perioperative period to improve long-term cancer outcomes","volume":"12","author":"Horowitz","year":"2015","journal-title":"Nat. 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