REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
n-3 PUFA-Supplemented Perioperative Immunonutrition on Postoperative Outcomes in Gastric Cancer: A Systematic Review and Meta-Analysis
Provisionally accepted
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China, Hengyang, China
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OBJECTIVE: To evaluate the impact of perioperative immunonutritional regimens that included n-3 polyunsaturated fatty acids (n-3 PUFAs)—ranging from n-3 PUFA monotherapy to complex formulas combined with other immunonutrients—on postoperative outcomes in gastric cancer patients. BACKGROUND: Although preventing postoperative complications is crucial for gastric cancer patients, consensus is lacking on the efficacy and optimal timing of administration of perioperative immunonutrition supplemented with n-3 PUFAs. METHODS: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) evaluating perioperative immunonutrition with n-3 PUFAs in gastric cancer surgery patients. Manual searches of reference lists were also conducted. The primary endpoint was total postoperative complications. Secondary endpoints included immune function (CD4+ T lymphocytes [CD4+ cells], CD8+ T lymphocytes [CD8+ cells], CD4+/CD8+ ratio, total lymphocytes, immunoglobulins IgA, IgG, IgM), nutritional status (transferrin, albumin, prealbumin), inflammatory markers (IL-6, TNF-α, CRP), and recovery indices (time to first flatus, length of hospital stay). Data were analyzed using RevMan v5.3 with a random-effect model. RESULTS: Sixteen RCTs involving 1642 patients were included. The meta-analysis demonstrated that perioperative n-3 PUFA supplementation significantly reduced the overall incidence of postoperative complications and promoted earlier recovery, as evidenced by a shortened time to first flatus and a reduced length of hospital stay. Furthermore, the n-3 PUFA group showed significant improvements in immunological (CD4+ T cell (%), CD4+/CD8+ ratio, total lymphocytes, IgA, IgG), inflammatory (IL-6, TNF-α, CRP), and nutritional (prealbumin) parameters. However, no significant differences were observed in CD8+ T cell (%), IgM, transferrin, or albumin levels between groups.
Keywords: gastric cancer, Immunotrition, n-3 PUFA, Perioperative, postoperative outcomes
Received: 03 Oct 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Yang, Zhou, Yang, Wei, Liang, Wang and Shan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hanguo Shan
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