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Oral nutritional supplements in the perioperative management of esophageal cancer: a narrative review focusing on evidence and clinical significance
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Yutaka Kimura
 , Atsushi Gakuhara, Chikato Koga
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Published online November 2, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0072
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 Abstract
- Purpose
Patients undergoing esophagectomy for esophageal cancer frequently experience malnutrition resulting from tumor-induced esophageal stenosis and surgical trauma. This narrative review evaluates the clinical significance of perioperative nutritional therapy, including pretreatment assessment, nutritional management during neoadjuvant chemotherapy (NAC), enteral nutrition strategies, and immunonutrition.
Current concept
Nutritional risk screening and diagnostic assessment using the Global Leadership Initiative on Malnutrition criteria are recommended before treatment. Pretreatment malnutrition and skeletal muscle loss are independently associated with greater chemotherapy-related toxicity and more postoperative infectious complications. During NAC, early intervention with oral nutritional supplements, elemental diets, or synbiotics effectively reduces treatment-related adverse events, preserves muscle mass, and maintains the integrity of the gut microbiota. After esophagectomy, early enteral nutrition, generally delivered by tube because oral intake is delayed, is clearly superior to parenteral nutrition in reducing complications such as pneumonia and optimizing metabolic recovery. Continued enteral tube feeding after discharge further preserves systemic lean mass. Immunonutrition formulas containing n-3 fatty acids, arginine, or nucleotides improve specific immunological and oxygenation parameters. However, recent randomized controlled trials and a network meta-analysis suggest that their overall efficacy in reducing primary surgical complications remains limited. Multidisciplinary prehabilitation that combines metabolic management with physical rehabilitation also shows increasing therapeutic promise.
Conclusion
Perioperative nutritional support is essential for reducing treatment toxicity and surgical morbidity in patients with esophageal cancer. However, current evidence indicates that immunonutrition offers limited benefit. Further well-designed randomized trials are needed to determine whether targeted perioperative nutritional strategies improve long-term oncological outcomes.
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