# Immunonutrition before cancer surgery

Source: https://onco.cc/technologies/immunonutrition-perioperative/  
OnCo record `immunonutrition-perioperative` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Drinks enriched with arginine, omega-3 fats and nucleotides for a week before a big operation seem to reduce infections afterwards, though the trials are old and mostly industry-funded.

## Summary

Immune-modulating formulas (arginine, omega-3 fatty acids, RNA nucleotides) given for 5-7 days pre-operatively reduced infectious complications and length of stay in meta-analyses of gastrointestinal and head and neck cancer surgery, with the largest effects in malnourished patients. ESPEN and ERAS guidelines recommend or suggest them for major upper GI and head and neck surgery. The caveats are real: many trials date from the 1990s and 2000s, most were manufacturer-sponsored, heterogeneity is high, and recent well-conducted trials have been null. Whether the benefit is from the immune-modulating components or simply from feeding malnourished patients is unresolved.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-09-08
- Principle: Arginine supports T-cell function and nitric oxide-dependent wound healing; omega-3 fatty acids shift eicosanoid synthesis towards less inflammatory mediators; nucleotides supply rapidly dividing immune and gut cells.
- Since: 1990
- Strengths: Reduced infectious complications in pooled analyses; Cheap and simple to deliver in the pre-operative window
- Limitations: Evidence base is old and largely industry-funded; Recent trials less positive; Unclear whether the specific nutrients matter

## Sources

- Cochrane: immunonutrition in GI surgery: https://doi.org/10.1002/14651858.CD008879.pub2

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/)
- terms: [Immunonutrition](https://onco.cc/terms/immunonutrition/), [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/)
- bottlenecks: [Preclinical results do not reproduce](https://onco.cc/bottlenecks/b-reproducibility/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- key papers: [Pre-operative nutrition support in patients undergoing gastrointestinal surgery](https://onco.cc/key-papers/paper-burden-cochrane-database-syst-rev/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/)

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