Annals of Clinical Nutrition and Metabolism

Review

Effectiveness of perioperative rehabilitation and nutrition in esophageal cancer: a narrative review: Ryoma Haneda, Yuki Sakai, Kenichi Sekimori, Tomohiro Murakami, Eisuke Booka, Tomohiro Matsumoto, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Hiroya Takeuchi; Ann Clin Nutr Metab 2026;18(1):18-26. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.25.0021

Abstract PDF: Purpose
Esophageal cancer surgery requires robust perioperative management to reduce its high rate of complications. This review evaluates the clinical utility of comprehensive exercise and nutritional therapy, with a specific focus on initiatives led by the multidisciplinary Hamamatsu Perioperative Care Team (HOPE), established at Hamamatsu University Hospital to optimize patient safety and postoperative recovery outcomes.
Current concept
The HOPE protocol involves a diverse team, including surgeons, nurses, pharmacists, and dietitians, who collaboratively implement a multifaceted perioperative care bundle. These interventions include strict smoking cessation, intensive oral care, and immunonutrition incorporating n-3 fatty acids. A distinctive feature of this program is the integration of patient-reported treatment diaries and wearable fitness tracking devices (WFTs) to visualize daily activity, thereby helping to sustain patient motivation. Preoperative rehabilitation focuses on preventing sarcopenia through combined aerobic and resistance training, while postoperative care emphasizes immediate enteral nutrition and early mobilization. Retrospective analyses demonstrated that HOPE implementation reduced Clavien-Dindo grade III or higher infectious complications, pneumonia and surgical site infections, compared with historical controls. In addition, a propensity score–matched analysis showed that WFT users experienced lower pneumonia rates, shorter hospital stays, and better preservation of nutritional markers, including albumin and transthyretin, during the recovery phase compared with non-users.
Conclusion
The HOPE strategy illustrates that combining standard nutritional support and exercise therapy with digital tools enables individualized rehabilitation. This integrated approach reduces morbidity and preserves function, strongly suggesting that incorporation of wearable technology into established surgical care protocols represents a strategy for improving long-term outcomes in high-risk cancer patients.

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Original Article

Impact of immune-supplementation on muscle health and inflammation status of South Indian patients who have undergone gastrointestinal resection: a pilot randomized-controlled study: Nivedita Pavithran, Catherine Bompart, Alisa Alili, Sudheer Othiyil Vayoth; Ann Clin Nutr Metab 2024;16(2):78-86. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.78

Abstract PDF: Purpose: Gastrointestinal (GI) resection significantly impacts nutritional and physical health, causing stress and inflammation that increase energy needs. Post-operative caloric intake often falls short, disrupting protein homeostasis and compromising muscle health. Nutritional supplementation is crucial to reduce inflammation and maintain muscle health. This study aimed to evaluate the impact of a three-week oral nutritional immuno-supplement (IMM) intervention compared to a control (CTL) on post-operative inflammatory status and muscle health in patients receiving limb and chest physiotherapy from June to August 2023.
Methods: A randomized, controlled, blinded cohort of 20 patients (ages 30–75) undergoing GI surgery was established. Participants were recruited on the day of surgery and assigned to either the CTL, which received standard protein supplementation, or the IMM group, which received protein immune-enriched supplementation for three weeks. All participants also received chest and limb physiotherapy. Follow-up and data collection were conducted at three post-surgery time points: 3 days, 7 days, and 3 weeks. Assessments included body composition, handgrip strength, basal metabolic rate, 24-hour dietary intake, and C-reactive protein (CRP) levels.
Results: Fifteen patients completed the study (IMM=9, CTL=6). After three weeks of supplementation, the IMM group showed a significant increase in lean mass percentage and handgrip strength, along with a significant decrease in CRP levels, compared to the CTL.
Conclusion: A 3-week oral immuno-supplement provided to patients post-GI resection, in conjunction with limb and chest physiotherapy, is more effective in reducing inflammation and preserving muscle health compared to standard protein supplementation.

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Reviews

Role of preoperative immunonutrition in patients with colorectal cancer: a narrative review: Soo Young Lee, Hyeung-min Park, Chang Hyun Kim, Hyeong Rok Kim; Ann Clin Nutr Metab 2023;15(2):46-50. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.46

Abstract PDF

Purpose: Colorectal cancer surgery presents challenges due to surgical stress and immunosuppression, leading to postoperative complications. Nutrition is crucial for colorectal cancer patients who are prone to malnutrition. This study aims to provide a comprehensive review of the role of preoperative immunonutrition in colorectal cancer surgery.
Current concept: Preoperative immunonutrition, consisting of immunonutrients such as arginine, ω-3 fatty acids, and nucleotides, has emerged as a potential strategy to enhance surgical outcomes by modulating immune responses and reducing complications. Current guidelines recommend preoperative oral nutritional supplements for major abdominal surgery and immunonutrition for nutritionally high-risk patients. Meta-analysis have demonstrated significant decreases in infectious complications and hospital stay durations with preoperative immunonutrition. However, limitations such as publication bias and heterogeneity in the previous studies should be considered. Further research should focus on the optimal timing, duration, and amount of immunonutrition; the patient populations that would benefit most; and the integration of immunonutrition into enhanced recovery after surgery protocols.
Conclusion: While preoperative immunonutrition shows promise, additional research is crucial to refine protocols and establish optimal clinical practice utilization.

Citations

Citations to this article as recorded by

The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Coloproctology.2025; 41(1): 3. CrossRef
Efficacy of preoperative immunonutrition in malnourished patients undergoing colorectal cancer surgery: a study protocol for a multicenter randomized clinical trial
Soo Young Lee, Chang Hyun Kim, Gi Won Ha, Soo Yeun Park, In Jun Yang, Jin Soo Kim, Gyung Mo Son, Sung Il Kang, Sung Uk Bae
Trials.2025;[Epub] CrossRef
The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Clinical Nutrition and Metabolism.2024; 16(2): 22. CrossRef

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Perioperative nutrition support: a narrative review: Rajeev Joshi, Asma Khalife; Ann Clin Nutr Metab 2023;15(2):40-45. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.40

Abstract PDF

Purpose: Proper nutrition and supplementation are paramount in surgical patients. Suboptimal nutrition status is increasingly recognized as an independent predictor of poor surgical outcomes. The purpose of this review is to highlight the need for nutritional protocols, with an emphasis on perioperative nutrition.
Current concept: Perioperative nutrition support is considered an adjunctive strategy in most centers, although it is proven to be the key in improving surgical outcomes. There is a need to increase the standards and formulate policies and protocols to optimize perioperative nutrition support. Components of perioperative nutrition include nutritional screening and assessment, prehabilitation, preoperative metabolic optimization and carbohydrate loading, postoperative early enteral feeding and perioperative parenteral nutrition, immunonutrition and micronutrients, and oral nutritional supplementation vs. hospital-based kitchen feeds. Supplemental parenteral nutrition becomes valuable when enteral nutrition alone cannot fulfil energy needs. In patients in the surgical intensive care unit who are dealing with hemodynamic instability, high levels of serum lactate unrelated to thiamine deficiency, acidosis, significant liver dysfunction, high blood sugar, and high blood lipid levels, parenteral nutrition must be started with caution. In the post-surgery care ward, it is advisable to administer up to 30 kcal/kg/day and 1.2–2 g/kg/day of protein.
Conclusion: The positive impact of comprehensive nutritional support and the importance of setting and executing standards must be highlighted. Emphasis should be placed on overcoming existing challenges in implementing nutrition therapy in current surgical practice, as better perioperative nutrition supports better surgical outcomes.

Citations

Citations to this article as recorded by

Preoperative Optimization in Patients with Diabetes Undergoing Foot and Ankle Surgery: BMI, Glycemic Control, and GLP-1 Agonists
Kaitlyn Leslie Hurka, Arun Kiran Movva, Anoop Sunkara, Siddhartha Kalala, Michael O’Connor Sohn, Kishen Mitra, Albert Thomas Anastasio
Diabetology.2026; 7(3): 54. CrossRef
Nutritional intervention for weight loss in presurgical phase – case study
Ana-Maria Damian
The Romanian Journal of Nutrition.2024; 4(4): 4. CrossRef

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