What question did this study set out to answer?

To evaluate the effectiveness of perioperative nutritional interventions on postoperative outcomes in colorectal surgery.

June 18, 2026

Perioperative nutrition therapy to optimize colorectal patient outcomes: A systematic review and meta‐analysis

Key Points

To evaluate the effectiveness of perioperative nutritional interventions on postoperative outcomes in colorectal surgery.
Conducted systematic review and meta-analysis of studies from 2000-2023.
Assessed interventions including protein supplementation, immunonutrition, carbohydrate loading, and postoperative diet progression.
Evaluated risk of bias and overall strength of evidence using standardized methods.
Twenty-seven studies included; ten showed low/moderate risk of bias.
Protein supplementation and immunonutrition may reduce surgical site infection rates compared to dietary advice alone; carbohydrate loading showed no significant difference.
Immunonutrition and carbohydrate loading likely do not affect length of stay and anastomotic leak rates.

Abstract

BACKGROUND: Malnutrition is an independent risk factor for postoperative complications-particularly surgical site infections-and recovery delays following colorectal surgery. While some evidence suggests perioperative nutritional interventions have the potential to decrease complication rates, this literature is heterogeneous with difficult to control implementation barriers. We conducted a systematic review and meta-analysis to appraise available evidence regarding perioperative nutritional interventions. METHODS: We searched Medline, Embase, CAB Abstracts, and CINAHL between 2000 and 2023 for studies assessing perioperative protein supplementation, immunonutrition, carbohydrate loading, and postoperative diet progression in colorectal surgery patients. Individual study risk of bias and overall strength of evidence (SOE) were evaluated using standardized methods. We used random-effects modeling for meta-analyses of study-level data when ≥3 studies were available. RESULTS: Twenty-seven eligible studies underwent data extraction. Ten were low/moderate risk of bias. Compared to dietary advice alone, protein supplementation and immunonutrition may show a benefit in lower surgical site infection rates, and carbohydrate loading may result in no difference (all low SOE). Both immunonutrition and carbohydrate loading probably do not impact anastomotic leak rates (moderate SOE). Immunonutrition and carbohydrate loading may result in no length of stay differences (low SOE). Evidence was insufficient assessing the optimal diet immediately following surgery. CONCLUSIONS: Perioperative colorectal surgery nutrition interventions are heterogeneous with current evidence suggesting small to negligible benefits regarding postoperative complications. No studies comparing low-fiber diet to regular diet met inclusion criteria. The majority of evidence is insufficient, highlighting research opportunities to further enhance nutritional optimization and limit complications.

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