PERIOPERATIVE NUTRITIONAL STRATEGIES IN COLORECTAL CANCER SURGERY: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5435Keywords:
Colorectal Cancer, Colon Cancer, Rectal Cancer, Colorectal Surgery, Colorectal Resection, Perioperative Nutrition, Nutritional Support, Oral Nutritional Supplementation, Oral Nutritional Supplements, Immunonutrition, Early Oral Feeding, Early Enteral Nutrition, Carbohydrate Loading, Prehabilitation, Randomized Controlled Trial, Randomized And RandomisedAbstract
Introduction and purpose: Perioperative nutritional care has become an increasingly important component of colorectal cancer (CRC) surgery, particularly in patients with malnutrition, sarcopenia, frailty, or increased metabolic vulnerability. This systematic review aimed to evaluate the effectiveness and safety of perioperative nutritional interventions in CRC surgery and to determine whether their clinical benefit is uniform or mainly concentrated in high-risk patients.
Material and methods: A systematic review of randomized controlled trials was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Cochrane Library, and Scopus were searched through March 12, 2026. Eligible studies included adult patients undergoing elective CRC surgery and evaluated carbohydrate loading, early oral feeding, oral nutritional supplementation, immunonutrition, or multimodal prehabilitation including a nutritional component. Primary outcomes were postoperative complications and length of hospital stay; secondary outcomes included infectious complications, anastomotic leakage, recovery parameters, metabolic response, patient-reported outcomes, and safety.
Results: Twenty-one randomized controlled trials were included. Early oral feeding and carbohydrate loading were mainly associated with improved postoperative recovery, gastrointestinal function, and patient-reported well-being, whereas their effects on major clinical endpoints were less consistent. Oral nutritional supplementation and targeted nutritional support appeared most beneficial in malnourished or nutritionally at-risk patients. Immunonutrition showed the clearest signal for reduced infectious morbidity and attenuation of perioperative inflammatory response. Multimodal prehabilitation improved functional recovery and appeared particularly relevant in frail or high-risk patients. Across intervention types, safety profiles were generally acceptable.
Conclusions: Perioperative nutritional interventions may provide clinically meaningful benefits in CRC surgery, but their effects are not uniform across all patients. Current evidence supports a risk-stratified approach, with the greatest benefit observed in patients with increased nutritional or physiological vulnerability.
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Copyright (c) 2026 Julia Sokołowska, Natalia Sitko, Paulina Makowska, Joanna Gontarczyk, Alicja Laske, Martyna Sowa , Antoni Majda, Julia Pająk, Anna Kamosińska , Adam Kowal, Hanna Aleksandrowicz
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