Effects of preoperative immunonutrition vs standard oral nutrition in patients undergoing colorectal surgery: A randomized controlled trial

doi:10.4240/wjgs.v17.i9.108127

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 9

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (208)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-2)

Tables (1-4)

Sum=79

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=118

Sep 27, 2025 (publication date) through Sep 27, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

World J Gastrointest Surg. Sep 27, 2025; 17(9): 108127
Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.108127

Effects of preoperative immunonutrition vs standard oral nutrition in patients undergoing colorectal surgery: A randomized controlled trial

Manivaasan Pannirselvam, Zaidi Zakaria, Michael Pak-Kai Wong, Mohd Hady Shukri Abdul Satar, Nor Syarahani Jusoh, Andee Dzulkarnaen Zakaria, Muhammad Faeid Othman

Manivaasan Pannirselvam, Zaidi Zakaria, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria, Muhammad Faeid Othman, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia

Mohd Hady Shukri Abdul Satar, Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia

Nor Syarahani Jusoh, Department of Dietetic and Food Services, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia

Co-corresponding authors: Andee Dzulkarnaen Zakaria and Muhammad Faeid Othman.

Author contributions: Pannirselvam M, Zakaria AD, Othman MF, and Wong MPK designed the overall concept and outline of the manuscript; Zakaria AD, Othman MF, Zakaria Z, Abdul Satar MHS, and Jusoh NS contributed to the discussion and design of the manuscript; Pannirselvam M, Zakaria AD, Othman MF, Zakaria Z, and Abdul Satar MHS contributed to the writing, and editing the manuscript, illustrations, and review of literature; Zakaria AD and Othman MF contributed equally to this work as co-corresponding authors. All authors have read and approved the final manuscript.

Supported by Universiti Sains Malaysia, Short-Term Grant, No. R501-LR-RND002-0000000342-0000.

Institutional review board statement: This study was approved by the Jawatankuasa Etika Penyelidikan Manusia Universiti Sains Malaysia, No. USM/JEPeM/KK/23050402.

Clinical trial registration statement: This study is registered at www.clinicaltrials.gov. The registration identification number is NCT06128798.

Informed consent statement: All study participants or their legal guardian, provided informed consent prior to study enrolment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The corresponding author will provide the data supporting this article upon request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Muhammad Faeid Othman, MD, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab II, Kubang Kerian 16150, Kelantan, Malaysia. faeid@usm.my

Received: April 8, 2025
Revised: May 27, 2025
Accepted: July 31, 2025
Published online: September 27, 2025
Processing time: 171 Days and 7.9 Hours

Abstract

BACKGROUND

Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery. Nonetheless, the advantages of preoperative immunonutrition remain controversial.

AIM

To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.

METHODS

This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024. In this study, the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients. Meanwhile, a conventional oral nutrition supplement was provided to the control group. The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded. Incidence of nosocomial infections, surgical site infections, and the total length of hospital stay were considered secondary data.

RESULTS

This study involved 58 patients who were allocated into two groups. No dropouts were documented. The mean age of the participants was 61.20 ± 12.96, and most were males (63.38%). All participants’ baseline and surgical characteristics in both arms were also generally comparable. The participants in this study underwent colorectal surgery, where most had laparoscopic surgery (58%). Based on the results, no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation, the onset of a normal diet, and hospital stay between the experimental and control groups. Both groups also recorded 10 (17.24%) infectious complications.

CONCLUSION

The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients. Conclusively, routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.

Keywords: Cancer surgery; Colorectal surgery; Gastrointestinal surgery; Immunonutrition; Postoperative complication

Core Tip: This randomized controlled trial evaluated the effects of preoperative immunonutrition vs standard oral nutrition supplements in patients undergoing colorectal surgery. Despite theoretical benefits, immunonutrition did not significantly improve postoperative gastrointestinal recovery, reduce infectious complications, or shorten hospital stay. All baseline and surgical variables were comparable between groups. The findings suggest that routine use of immunonutrition may not confer additional clinical advantages over standard supplementation in this patient population, challenging current recommendations and supporting a more individualized nutritional approach.