• neoadjuvant chemotherapy
• nutritional status
• pancreatic cancer
• survival rate

• Humans
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/therapy
• Male
• Female
• Neoadjuvant Therapy/methods
• Retrospective Studies
• Nutritional Status
• Middle Aged
• Aged
• Prognosis
• Chemotherapy, Adjuvant/methods
• Disease-Free Survival
• Nutrition Assessment

• free flap
• head and neck reconstruction
• hypoalbuminemia
• malnutrition
• microvascular surgery
• surgical outcomes

• Humans
• Hypoalbuminemia/complications
• Female
• Male
• Retrospective Studies
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Aged
• Head and Neck Neoplasms/surgery
• Plastic Surgery Procedures/adverse effects
• Plastic Surgery Procedures/methods
• Risk Factors
• Microsurgery/adverse effects
• Microsurgery/methods
• Preoperative Period
• Free Tissue Flaps/adverse effects
• Adult

• CiteSpace
• VOSviewer
• bibliometrics
• malnutrition
• nutritional supplements
• sick people

• Complications
• Imperforate anus
• Risk factors
• Surgical factors
• Surgical site infection

• Humans
• Retrospective Studies
• Risk Factors
• Anorectal Malformations/surgery
• Male
• Surgical Wound Infection/epidemiology
• Plastic Surgery Procedures/methods
• Female
• Infant
• Anal Canal/surgery
• Anal Canal/abnormalities
• Child, Preschool
• Japan/epidemiology
• Child
• Infant, Newborn

• Humans
• Aged
• Female
• Male
• Nutritional Status
• Aged, 80 and over
• Wounds and Injuries/complications
• Wounds and Injuries/mortality
• Malnutrition/epidemiology
• Malnutrition/diagnosis
• Malnutrition/etiology
• Geriatric Assessment
• Prospective Studies
• Injury Severity Score
• Nutrition Assessment
• Trauma Centers/statistics & numerical data
• Patient Discharge/statistics & numerical data
• Risk Assessment
• Risk Factors

• humans
• middle aged
• bias
• digestive system surgical procedures
• digestive system surgical procedures/adverse effects
• enteral nutrition
• enteral nutrition/methods
• length of stay
• malnutrition
• nutritional status
• parenteral nutrition
• postoperative complications
• postoperative complications/prevention & control
• preoperative care
• preoperative care/methods
• quality of life
• randomized controlled trials as topic

• Humans
• Randomized Controlled Trials as Topic
• Preoperative Care/methods
• Postoperative Complications/prevention & control
• Length of Stay
• Digestive System Surgical Procedures/adverse effects
• Parenteral Nutrition
• Bias
• Enteral Nutrition/methods
• Nutritional Status
• Quality of Life
• Malnutrition
• Middle Aged

• CD8+
• Enteral immunonutrition
• enteral nutrition
• gastric cancer
• immune function
• infectious complications
• meta-analysis
• proalbumin

• Humans
• Stomach Neoplasms/surgery
• Enteral Nutrition/methods
• Immunonutrition Diet
• Digestive System Surgical Procedures
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Randomized Controlled Trials as Topic

• bibliometric analysis
• cancer
• immune system
• immunonutrition
• nutrition

• Humans
• Immunonutrition Diet
• Algorithms
• Bibliometrics
• Cluster Analysis
• France
• Neoplasms/therapy

• HALP
• Pancreatic cancer
• Postoperative outcome
• Psoas muscle volume
• Sarcopenia

• Female
• Humans
• Male
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology
• Hemoglobins/analysis
• Lymphocytes/chemistry
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/pathology
• Pancreaticoduodenectomy
• Postoperative Complications/epidemiology
• Postoperative Complications/pathology
• Prognosis
• Retrospective Studies
• Sarcopenia/complications
• Sarcopenia/pathology

• Humans
• Immunonutrition Diet
• Postoperative Complications
• Surgical Wound Infection
• Neoplasms/therapy
• Muscles

• Adult
• Humans
• Quality of Life
• Diet
• Body Weight
• Head and Neck Neoplasms

• NIH HHS
• National Institutes of Health

• nutrition
• nutritional assesment
• onco-surgery
• postoperative nutrition care
• preoperative nutrition care
• screening of nutritional status
• screening tools
• special diet

• Gastric cancer
• Laparoscopic jejunostomy

The efficacy of enteral immunonutrition (EIN) in patients undergoing gastrointestinal cancer surgery remains debatable. This meta-analysis aimed to investigate the effectiveness of EIN administration in patients undergoing surgery for gastrointestinal cancer.

From January 2000 to January 2022, PubMed, EMBASE, Cochrane Library, and Web of Science were thoroughly searched for randomized controlled trials (RCTs) with EIN versus standard diet or no supplement in patients undergoing surgery for gastrointestinal cancer. Overall complications and infectious complications were the primary outcomes. The secondary results were non-infectious complications, mortality, length of hospital stay, and enteral nutrition-related complications.

Thirty-five studies reporting 3,692 patients undergoing surgery for gastrointestinal cancer (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer) were included. Compared with the control group, EIN group had a significantly decreased incidence of overall complications (RR = 0.79, p < 0.001). Infectious complications in patients who received EIN were considerably lower than in the control group (RR = 0.66, p < 0.001). Compared to the control group, the incidence of surgical site infection, abdominal abscess, anastomotic leakage, bacteremia, duration of systemic inflammatory response syndrome (SIRS), and duration of antibiotic therapy was significantly lower in the specific infectious complications treated with EIN. Still, there was no significant difference between the two groups with other infectious complications. Moreover, a substantial shortening in the length of hospital stay was shown in EIN group compared with the control group. Still, no significant effect of EIN was demonstrated in non-infectious complicatios and mortality. The enteral nutrition-related complications had no significant difference between two groups.

EIN is safe and effective in reducing overall complications, infectious complications, and hospital stay in patients undergoing gastrointestinal cancer surgery (including gastric cancer, colorectal cancer, esophageal cancer, periampullary cancer, or pancreatic cancer).

• immune-enhancing
• nutrition
• omega-3 fatty acids
• perforation peritonitis
• post operative outcome

The aim of this study was to establish a nurse-led supportive care program based on telephone and Internet support and evaluate its efficacy in comparison with conventional care on enhanced recovery after surgery.

The study was designed as an open-label, randomized controlled trial to value the efficacy of a nurse-led supportive care program in comparison with conventional care. A convenience sampling method was employed to recruit patients with esophageal cancer in a tertiary Grade A cancer center in Beijing from November 2018 to January 2019. Patients were assigned randomly (1:1) to one of the two groups (intervention group vs control group) via a web randomization system. The control group received conventional care. Patients from the intervention group received conventional care and one-on-one phone calls from nurses following their discharge assessments and education about nutrition and symptoms. Nurses also set up a WeChat group, which they invited patients to join in before discharge for better communication during follow-up. Statistical testing, including nutritional status, quality of life, the helpfulness of the follow-up service, and the patients’ satisfaction with their care, was conducted 6 months after discharge to assess for differences between the two groups. The independent sample t, chi-squared, and Mann–Whitney tests were used to compare between the experiences of the intervention and control groups. The Spearman correlation analysis was used for the analysis of correlation of the nutritional index and quality of life.

Finally, 168 patients were included in the study, with 86 patients in the intervention group and 82 in the control group. Significant differences between the intervention and control groups were found in the nutrition risk screening 2002 and simple diet self-assessment tool scores. The changes in blood albumin, prealbumin, and transferrin were also statistically significant. All (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) QLQ-C30 results of the intervention group were better than those of the control group. A significant positive correlation of the simple diet self-assessment tool (the higher, the better) and the scores for total health/quality of life were detected (r ​= ​0.214, P ​= ​0.005). A significant negative correlation of the nutrition risk screening 2002 (the lower, the better) and the scores of total health/quality of life was detected (r ​= ​−0.446, P ​= ​0.000). The patients’ scores on the helpfulness of the follow-up service and their satisfaction with it were both significantly higher in the intervention group than in the control group.

This study highlighted the important role of nurse-led supportive care based on telephone and Internet-based support for patients after enhanced recovery after surgery. The supportive care improved patients’ nutritional status, elevated their quality of life, and improved their satisfaction with the care provided to them.

• enteral nutrition
• immune factor
• inflammatory factor
• liver cancer

• Aged
• Biomarkers/blood
• Enteral Nutrition
• Female
• Flatulence
• Hepatectomy/adverse effects
• Humans
• Immunologic Factors
• Inflammation Mediators/blood
• Interleukin-1
• Interleukin-6
• Length of Stay
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Tumor Necrosis Factor-alpha

• Pancreaticoduodenectomy (PD)
• nutritional assessment
• sarcopenia
• total parenteral nutrition (TPN)

• Anastomotic leak
• Anastomotic stricture
• Colorectal surgery
• Urinary retention

• Bariatric surgery
• ERAS
• Nutritional therapy
• Organ transplantation
• Perioperative nutrition
• Prehabilitation
• Surgery

• Enhanced Recovery After Surgery/standards
• Enteral Nutrition/standards
• Humans
• Malnutrition/prevention & control
• Nutrition Therapy/standards
• Perioperative Care/methods
• Perioperative Care/standards
• Postoperative Complications/prevention & control
• Postoperative Period

• MR/P021220/1 Medical Research Council

• Crohn's disease
• inflammatory bowel diseases
• malnutrition
• postoperative morbidity
• preoperative enteral nutritional support

• Aged
• Digestive System Neoplasms/immunology
• Digestive System Neoplasms/therapy
• Digestive System Surgical Procedures
• Female
• Follow-Up Studies
• France/epidemiology
• Humans
• Immunologic Factors/therapeutic use
• Immunomodulation
• Length of Stay/trends
• Male
• Morbidity/trends
• Population Surveillance/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Preoperative Care/methods
• Prospective Studies
• Survival Rate/trends
• Treatment Outcome

• dietary reference intake
• distinctive nutritional requirements
• enteral nutrition
• foods for special dietary use
• medical foods
• nutritional supplements
• oral nutritional supplements

• HNC

• Antibiotics
• Drain
• Guidelines
• Surgical site infection

• Antibiotic Prophylaxis
• Digestive System Surgical Procedures/adverse effects
• Humans
• Japan
• Perioperative Care
• Practice Guidelines as Topic
• Societies, Medical/organization & administration
• Surgical Wound Infection/diagnosis
• Surgical Wound Infection/etiology
• Surgical Wound Infection/prevention & control
• Surgical Wound Infection/therapy

Most cholangiocarcinoma patients with malignant obstructive jaundice (MOJ) have varying degrees of malnutrition and immunodeficiency preoperatively. Therefore, perioperative nutritional support has important clinical significance in the treatment of cholangiocarcinoma.

To investigate the effects of postoperative early enteral nutrition (EEN) on immunity function and clinical outcomes of cholangiocarcinoma patients with MOJ.

This prospective clinical study included 60 cholangiocarcinoma patients with MOJ who underwent surgery. The patients were randomly divided into an experimental group and a control group according to the nutrition support modes. The control group received postoperative total parenteral nutrition (TPN), whereas the experimental group received postoperative EEN and parenteral nutrition (PN; EEN + PN). The clinical outcomes, postoperative immune function, incidences of surgical site infection and bile leakage, intestinal function recovery time, average hospitalization days, and hospitalization expenses of the two groups were assessed on postoperative days (PODs) 1, 3, and 7.

The CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T cell count and the immunoglobulin (Ig) G, IgM, and IgA levels in the EEN + PN group were significantly higher than those in the TPN group on PODs 3 and 7 (P < 0.05), whereas no significant differences in the CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T cell counts and IgG, IgM, and IgA levels before operation and on POD 1 were found between the two groups (P > 0.05). The intestinal function recovery time and postoperative hospital stay were shorter (P < 0.001 for both) in the EEN + PN group than in the TPN group. The hospitalization expenses of the EEN + PN group were lower than those of the TPN group (P < 0.001). However, the incidence of abdominal distension was higher than in the EEN + PN group than in the TPN group (P < 0.05). The incidence rates of biliary leakage and surgical site infection were not significantly different between the two groups (P > 0.05).

A postoperative EEN program could reduce the incidence of postoperative complications and improve the clinical outcomes and immune functions of cholangiocarcinoma patients with MOJ and is thus beneficial to patient recovery.

• Clinical outcomes
• Early enteral nutrition
• Immune function
• Nutritional status
• Malignant obstructive jaundice
• Cholangiocarcinoma

• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma/surgery
• Enteral Nutrition
• Humans
• Immunity
• Jaundice, Obstructive/etiology
• Jaundice, Obstructive/therapy
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prospective Studies

• Hepatectomy
• Immunonutrition
• Meta-analysis
• Randomized controlled trials

For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history- acute, chronic and recurrent.

To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Diverticular disease was rarely described in the literature prior to the 1900’s. In the late 1960’s and early 1970’s, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Previous surgical guidelines focused on early operative intervention to avoid potential complicated episodes of recurrent complicated diverticulitis (e.g., with free perforation) that might necessitate emergent surgery and stoma formation. More recent data has challenged prior concerns about decreasing effectiveness of medical management with repeat episodes and the notion that the natural history of diverticulitis is progressive. It has also permitted more accurate grading of the severity of disease and permitted less invasive management options to attempt conversion of urgent operations into the elective setting, or even avoid an operation altogether.

The role of diet in preventing diverticular disease has long been debated. A high fiber diet appears to decrease the likelihood of symptomatic diverticulitis. The myth of avoid eating nuts, corn, popcorn, and seeds to prevent episodes of diverticulitis has been debunked with modern data. Overall, the recommendations for “diverticulitis diets” mirror those made for overall healthy lifestyle – high fiber, with a focus on whole grains, fruits and vegetables.

Diverticulosis is one of the most common incidental findings on colonoscopy and the eighth most common outpatient diagnosis in the United States. Over 50% of people over the age of 60 and over 60% of people over age 80 have colonic diverticula. Of those with diverticulosis, the lifetime risk of developing diverticulitis is estimated at 10–25%, although more recent studies estimate a 5% rate of progression to diverticulitis. Diverticulitis accounts for an estimated 371,000 emergency department visits and 200,000 inpatient admissions per year with annual cost of 2.1–2.6 billion dollars per year in the United States. The estimated total medical expenditure (inpatient and outpatient) for diverticulosis and diverticulitis in 2015 was over 5.4 billion dollars. The incidence of diverticulitis is increasing.

Besides increasing age, other risk factors for diverticular disease include use of NSAIDS, aspirin, steroids, opioids, smoking and sedentary lifestyle. Diverticula most commonly occur along the mesenteric side of the antimesenteric taeniae resulting in parallel rows. These spots are thought to be relatively weak as this is the location where vasa recta penetrate the muscle to supply the mucosa. The exact mechanism that leads to diverticulitis from diverticulosis is not definitively known.

The most common presenting complaint is of left lower quadrant abdominal pain with symptoms of systemic unwellness including fever and malaise, however the presentation may vary widely. The gold standard cross-sectional imaging is multi-detector CT. It is minimally invasive and has sensitivity between 98% and specificity up to 99% for diagnosing acute diverticulitis. Uncomplicated acute diverticulitis may be safely managed as an out-patient in carefully selected patients. Hospitalization is usually necessary for patients with immunosuppression, intolerance to oral intake, signs of severe sepsis, lack of social support and increased comorbidities. The role of antibiotics has been questioned in a number of randomized controlled trials and it is likely that we will see more patients with uncomplicated disease treated with observation in the future

Acute diverticulitis can be further sub classified into complicated and uncomplicated presentations. Uncomplicated diverticulitis is characterized by inflammation limited to colonic wall and surrounding tissue. The management of uncomplicated diverticulitis is changing. Use of antibiotics has been questioned as it appears that antibiotic use can be avoided in select groups of patients. Surgical intervention appears to improve patient’s quality of life. The decision to proceed with surgery is recommended in an individualized manner.

Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Abscesses can be treated with percutaneous drainage if the abscess is large enough. The optimal long-term strategy for patients who undergo successful non-operative management of their diverticular abscess remains controversial. There are clearly patients who would do well with an elective colectomy and a subset who could avoid an operation all together however, the challenge is appropriate risk-stratification and patient selection. Management of patients with perforation depends greatly on the presence of feculent or purulent peritonitis, the extent of contamination and hemodynamic status and associated comorbidities. Fistulas and strictures are almost always treated with segmental colectomy.

After an episode of acute diverticulitis, routine colonoscopy has been recommended by a number of societies to exclude the presence of colorectal cancer or presence of alternative diagnosis like ischemic colitis or inflammatory bowel disease for the clinical presentation. Endoscopic evaluation of the colon is normally delayed by about 6 weeks from the acute episode to reduce the risk associated with colonoscopy. Further study has questioned the need for endoscopic evaluation for every patient with acute diverticulitis. Colonoscopy should be routinely performed after complicated diverticulitis cases, when the clinical presentation is atypical or if there are any diagnostic ambiguity, or patient has other indications for colonoscopy like rectal bleeding or is above 50 years of age without recent colonoscopy.

For patients in whom elective colectomy is indicated, it is imperative to identify a wide range of modifiable patient co-morbidities. Every attempt should be made to improve a patient’s chance of successful surgery. This includes optimization of patient risk factors as well as tailoring the surgical approach and perioperative management. A positive outcome depends greatly on thoughtful attention to what makes a complicated patient “complicated”.

Operative management remains complex and depends on multiple factors including patient age, comorbidities, nutritional state, severity of disease, and surgeon preference and experience. Importantly, the status of surgery, elective versus urgent or emergent operation, is pivotal in decision-making, and treatment algorithms are divergent based on the acuteness of surgery. Resection of diseased bowel to healthy proximal colon and rectal margins remains a fundamental principle of treatment although the operative approach may vary.

For acute diverticulitis, a number of surgical approaches exist, including loop colostomy, sigmoidectomy with colostomy (Hartmann’s procedure) and sigmoidectomy with primary colorectal anastomosis. Overall, data suggest that primary anastomosis is preferable to a Hartman’s procedure in select patients with acute diverticulitis. Patients with hemodynamic instability, immunocompromised state, feculent peritonitis, severely edematous or ischemic bowel, or significant malnutrition are poor candidates. The decision to divert after colorectal anastomosis is at the discretion of the operating surgeon. Patient factors including severity of disease, tissue quality, and comorbidities should be considered. Technical considerations for elective cases include appropriate bowel preparation, the use of a laparoscopic approach, the decision to perform a primary anastomosis, and the selected use of ureteral stents.

Management of the patient with an end colostomy after a Hartmann’s procedure for acute diverticulitis can be a challenging clinical scenario. Between 20 – 50% of patients treated with sigmoid resection and an end colostomy after an initial severe bout of diverticulitis will never be reversed to their normal anatomy. The reasons for high rates of permanent colostomies are multifactorial. The debate on the best timing for a colostomy takedown continues. Six months is generally chosen as the safest time to proceed when adhesions may be at their softest allowing for a more favorable dissection. The surgical approach will be a personal decision by the operating surgeon based on his or her experience. Colostomy takedown operations are challenging surgeries. The surgeon should anticipate and appropriately plan for a long and difficult operation. The patient should undergo a full antibiotic bowel preparation. Preoperative planning is critical; review the initial operative note and defining the anatomy prior to reversal. When a complex abdominal wall closure is necessary, consider consultation with a hernia specialist. Open surgery is the preferred surgical approach for the majority of colostomy takedown operations. Finally, consider ureteral catheters, diverting loop ileostomy, and be prepared for all anastomotic options in advance.

Since its inception in the late 90’s, laparoscopic lavage has been recognized as a novel treatment modality in the management of complicated diverticulitis; specifically, Hinchey III (purulent) diverticulitis. Over the last decade, it has been the subject of several randomized controlled trials, retrospective studies, systematic reviews as well as cost-efficiency analyses. Despite being the subject of much debate and controversy, there is a clear role for laparoscopic lavage in the management of acute diverticulitis with the caveat that patient selection is key.

Segmental colitis associated with diverticulitis (SCAD) is an inflammatory condition affecting the colon in segments that are also affected by diverticulosis, namely, the sigmoid colon. While SCAD is considered a separate clinical entity, it is frequently confused with diverticulitis or inflammatory bowel disease (IBD). SCAD affects approximately 1.4% of the general population and 1.15 to 11.4% of those with diverticulosis and most commonly affects those in their 6th decade of life. The exact pathogenesis of SCAD is unknown, but proposed mechanisms include mucosal redundancy and prolapse occurring in diverticular segments, fecal stasis, and localized ischemia. Most case of SCAD resolve with a high-fiber diet and antibiotics, with salicylates reserved for more severe cases. Relapse is uncommon and immunosuppression with steroids is rarely needed. A relapsing clinical course may suggest a diagnosis of IBD and treatment as such should be initiated. Surgery is extremely uncommon and reserved for severe refractory disease.

While sigmoid colon involvement is considered the most common site of colonic diverticulitis in Western countries, diverticular disease can be problematic in other areas of the colon. In Asian countries, right-sided diverticulitis outnumbers the left. This difference seems to be secondary to dietary and genetic factors. Differential diagnosis might be difficult because of similarity with appendicitis. However accurate imaging studies allow a precise preoperative diagnosis and management planning. Transverse colonic diverticulitis is very rare accounting for less than 1% of colonic diverticulitis with a perforation rate that has been estimated to be even more rare. Rectal diverticula are mostly asymptomatic and diagnosed incidentally in the majority of patients and rarely require treatment. Giant colonic diverticula (GCD) is a rare presentation of diverticular disease of the colon and it is defined as an air-filled cystic diverticulum larger than 4 cm in diameter. The pathogenesis of GCD is not well defined.

Overall, the management of diverticular disease depends greatly on patient, disease and surgeon factors. Only by tailoring treatment to the patient in front of us can we achieve optimal outcomes.

• Age Factors
• Colonoscopy
• Diagnostic Imaging
• Digestive System Surgical Procedures
• Disease Management
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/therapy
• Humans
• Risk Factors

• K23 DK118192 NIDDK NIH HHS

• Hepatectomy/adverse effects
• Humans
• Malnutrition/diagnosis
• Malnutrition/epidemiology
• Malnutrition/etiology
• Nutrition Assessment
• Nutritional Status
• Pancreatectomy/adverse effects
• Retrospective Studies

• Complications
• Feeding tube
• Jejunostomy
• Surgical outcome

• ERAS
• colorectal cancer
• colorectal surgery
• diverticulosis
• enhanced recovery

Infectious complications occur in 4–22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta‐analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30‐day mortality in patients undergoing oncological surgery.

PubMed, Embase and Cochrane Library databases were searched to identify eligible studies.

Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical‐site infection (SSI) and 30‐day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology.

Some 22 RCTs with 2159 participants were eligible for meta‐analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0·58, 95 per cent c.i. 0·48 to 0·70; I² = 7 per cent; TSA‐adjusted 95 per cent c.i. 0·28 to 1·21) and SSI (RR 0·65, 95 per cent c.i. 0·50 to 0·85; I² = 0 per cent; TSA‐adjusted 95 per cent c.i. 0·21 to 2·04). Thirty‐day mortality was not altered by immunonutrition (RR 0·69, 0·33 to 1·40; I² = 0 per cent).

Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.

• Neoadjuvant chemotherapy
• Nutrition assessment
• Pancreatic cancer
• Prognostic nutritional index

• Ejercicio físico
• Mindfulness
• Multimodal
• Nutritional supplementation
• Physical exercise
• Prehabilitación
• Prehabilitation
• Suplementación nutricional

• Anemia/therapy
• Anxiety/prevention & control
• Body Composition
• Cardiorespiratory Fitness/physiology
• Enhanced Recovery After Surgery
• Exercise
• Humans
• Medication Reconciliation
• Mindfulness
• Nutritional Status
• Physical Conditioning, Human
• Physical Functional Performance
• Postoperative Complications/prevention & control
• Preoperative Exercise/physiology
• Psychological Tests
• Smoking Cessation
• Stress, Physiological/physiology
• Walk Test