Karmakar R, Kandalkar A, Wang HC, Mukundan A. Concentrated enteral nutrition in colorectal cancer surgery: Recovery K5 signal and research priorities. World J Gastrointest Surg 2026; 18(7): 114573 [DOI: 10.4240/wjgs.114573]
Corresponding Author of This Article
Arvind Mukundan, PhD, Assistant Professor, Postdoctoral Fellow, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Min Hsiung, Chiayi 62102, Taiwan. arvindmukund96@gmail.com
Research Domain of This Article
Surgery
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editorial
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Karmakar R, Kandalkar A, Wang HC, Mukundan A. Concentrated enteral nutrition in colorectal cancer surgery: Recovery K5 signal and research priorities. World J Gastrointest Surg 2026; 18(7): 114573 [DOI: 10.4240/wjgs.114573]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 114573 Published online Jul 27, 2026. doi: 10.4240/wjgs.114573
Concentrated enteral nutrition in colorectal cancer surgery: Recovery K5 signal and research priorities
Riya Karmakar, Aditya Kandalkar, Hsiang-Chen Wang, Arvind Mukundan
Riya Karmakar, Hsiang-Chen Wang, Arvind Mukundan, Department of Mechanical Engineering, National Chung Cheng University, Chiayi 62102, Taiwan
Riya Karmakar, Arvind Mukundan, School of Engineering and Technology, Sanjivani University, Sanjivani Factory, Kopargaon 423603, Maharashtra, India
Aditya Kandalkar, Department of Information Technology, Sanjivani College of Engineering, Kopargaon 423603, Maharashtra, India
Co-first authors: Riya Karmakar and Aditya Kandalkar.
Co-corresponding authors: Hsiang-Chen Wang and Arvind Mukundan.
Author contributions: Karmakar R and Kandalkar A made equal contributions as co-first authors. Mukundan A, Kandalkar A, Karmakar R, and Wang HC contributed to conceptualization, review, and editing; Mukundan A and Wang HC contributed to formal analysis and project administration; Karmakar R and Kandalkar A contributed to investigation and software; Wang HC contributed to supervision; Kandalkar A wrote the original draft. Mukundan A and Wang HC contributed equally to the manuscript as co-corresponding authors. All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Corresponding author: Arvind Mukundan, PhD, Assistant Professor, Postdoctoral Fellow, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Min Hsiung, Chiayi 62102, Taiwan. arvindmukund96@gmail.com
Received: September 23, 2025 Revised: October 10, 2025 Accepted: December 10, 2025 Published online: July 27, 2026 Processing time: 307 Days and 16.5 Hours
Abstract
In this editorial, we comment on the article by Shinji et al published in the recent issue of the World Journal of Gastrointestinal Surgery. Colorectal cancer ranks as the second leading cause of cancer-related mortality globally, with postoperative surgical site infections (SSIs) occurring in up to 22.5% of cases, significantly contributing to morbidity and costs. Malnutrition is a well-known contributor to postoperative morbidity and mortality, and preoperative nutrition is a significant modifiable risk factor associated with SSIs. Recovery K5 (RK5) is a concentrated liquid formulation that combines balanced soy and milk proteins with collagen peptides for peristress and recovery support. The RK5 trial provides an early signal in this domain and highlights the need for larger multicenter validation, as reported by Shinji et al. It integrates soy and milk proteins in balanced ratios, accompanied by collagen peptides, rendering it appropriate for nutritional support throughout both stress and recovery stages. The RK5 study showed a decrease in the frequency of SSIs from 33.3% to 5.9% (P = 0.0695). The proportion of patients who were able to achieve target energy intake was higher in the RK5 group, which highlighted challenges in meeting perioperative nutritional goals. Immunonutrition improves immune function and affects the tumor environment, which may help people live longer after planned colorectal cancer surgery. Evidence of moderate certainty indicates that perioperative nutritional supplements reduce SSI risk (odds ratio = 0.54, 95% confidence interval: 0.40-0.72). Economic assessments report that immunonutrition may save money by decreasing complications, length of stay, and readmissions; these estimates depend on confirmed clinical benefit and local cost structures. Accordingly, reported savings should be seen as scenario estimates rather than actual outcomes until effectiveness is confirmed in randomized trials and validated locally. This editorial reviews the RK5 findings and supports evaluation within research or step-by-step implementation frameworks rather than routine implementation at this stage.
Core Tip: Recovery K5 is a concentrated liquid formulation with a balanced blend of soy and milk proteins, together with collagen peptides. The recovery K5 study demonstrated a non-significant trend in the reduction of surgical site infections, decreasing from 33.3% to 5.9%, P = 0.0695. Economic consequences must be regarded as modeled and dependent on verified therapeutic benefits and local expenses; hence, no actual savings are asserted.
