Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.110068
Revised: June 9, 2025
Accepted: August 25, 2025
Published online: September 24, 2025
Processing time: 117 Days and 22.6 Hours
Postoperative malnutrition, systemic inflammation, and immune dysfunction significantly impair recovery and survival in gastric cancer patients undergoing radical gastrectomy. The Prognostic Immune Nutritional Index (PINI) enables immune-nutritional risk stratification; however, its utility in guiding perioperative nutritional support remains underexplored.
To evaluate whether risk-stratified perioperative nutritional support based on PINI scores improves postoperative recovery, quality of life, and long-term out
In this prospective, randomized controlled trial, 195 patients undergoing radical gastrectomy were stratified into low- (PINI ≤ 1.5), moderate- (1.5 < PINI ≤ 3), and high-risk (PINI > 3) groups. Patients received standard, intensive, or immune-enhancing nutritional support, respectively. Outcomes were assessed at 1 week, 1 month, and 1 year postoperatively and included body mass index (BMI), serum albumin, PINI scores, Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analog Scale (VAS) for pain, EORTC QLQ-C30 for quality of life, complication rates, hospital stay, and survival.
At 1 year, the high-risk group receiving immune-enhancing nutrition demon
PINI-based graded nutritional support significantly enhances postoperative recovery, reduces complications, and improves long-term outcomes following radical gastrectomy. These findings support its integration into precision perioperative care strategies for gastric cancer.
Core Tip: This randomized controlled trial is the first to apply Prognostic Immune Nutritional Index (PINI)-based risk stratification to guide perioperative nutritional support in gastric cancer patients. The tailored interventions significantly improved sleep quality, psychological well-being, nutritional status, and 1-year survival, particularly in high-risk individuals. Our findings highlight the value of individualized immune-enhancing nutrition in optimizing recovery and suggest that PINI may serve as a practical tool for precision perioperative care.