Immunonutrition of perioperative therapy for colorectal cancer

Immunonutrition, a modified nutritional formula that involves the addition of glutamine, arginine, omega-3 fatty acids, nucleotides, and other potential compounds to the diet, has proven its potential for use in immunomodulation and protein metabolism improvement. Its clinical benefits include shortening hospital stays and lowering surgical infectious complications in upper gastrointestinal surgery. However, the use of perioperative immunonutrition is rare among colorectal cancer patients undergoing surgical intervention. Colorectal cancer is one of the most common cancers around the world, but its malnutrition rate is not high in comparison with other cancers (eg, gastric cancer or esophageal cancer). Furthermore, the surgical modality for the majority of colorectal cancer patients involves minimal invasive surgery (MIS), which enhances recovery speed. It is an interesting clinical question whether or not perioperative immunonutrition supplementation for colorectal cancer patients undergoing MIS causes extraclinical impacts. The immunomodulation effect of CD4(+) T cells has been proven in colorectal patients undergoing elective surgery. In recent years, there have been several prospective randomized studies elucidating the clinical effects of immunonutrition on colorectal cancer patients undergoing surgery in Western countries. These studies have generally found that perioperative immunonutrition was associated with a lower rate of surgical infectious complications even in normo-nourished patients undergoing MIS. The use of perioperative immunonutrition provides clinical benefits according to high-quality studies. However, most results come from Western countries, and its effect needs to be validated in Asian countries.