Malnutrition is common among patients undergoing cancer surgery, yet guideline-recommended perioperative nutritional care is inconsistently implemented. We evaluated outpatient nutritional counseling before and after integration of a dedicated registered dietitian (RD) into a surgical oncology clinic. We conducted a retrospective cohort study of adults undergoing oncologic surgery from January 2021 through August 2025. The primary outcome was documented perioperative RD counseling; postoperative outcomes were exploratory. Among 234 surgeries, 133 preceded RD integration and 101 followed it. Counseling increased from 15.0% (20/133) to 65.3% (66/101; P < 0.001). Post-integration patients had higher odds of counseling (OR 10.65, 95% CI 5.69-19.96). Counseled patients had lower baseline BMI, suggesting preferential referral of patients at greater nutritional risk. Dedicated RD integration substantially improved access to perioperative nutritional counseling, a clinically meaningful step toward timely, individualized nutrition assessment and intervention, while identifying opportunities to strengthen referral pathways and documentation.
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