免疫营养（IMN）在胃肠道（GI）癌症手术中的利用仍未充分和有争议。虽然之前的Meta分析报告表明有益处，但是最近的大多数随机对照试验（RCT）未能证明其益处，并建议不要常规使用。现代Meta分析可能有助于推荐使用免疫营养和帮助选择哪些患者可能获益。该研究的目标是回顾IMN及其对GI癌症手术后结果的影响，探讨其在营养不良和非营养不良人群中的作用、最佳使用剂量、使用IMN的癌症类型以及IMN相对于围手术期的时间。 从2000年至2022年，EMBASE和Medline数据库中搜索评估接受GI癌症手术的成人的IMN的RCT。共纳入了37项研究（22项术前IMN研究，11项围手术期IMN试验和9项术后IMN试验；4项试验有多个IMN方案），涉及3793个患者。术后感染并发症的主要结果与IMN相关联（比值比[OR]为0.58，95%置信区间[CI]为0.47-0.72）。在亚组分析中，这种关联仅在术前和围手术期给药以及包括上GI癌症、结直肠癌和“混合GI”癌症人群的试验中显著，并且其显著性独立于营养状态。汇总分析中，IMN减少了手术部位感染（SSI）（OR 0.65，95% CI 0.52-0.81），吻合口漏（OR 0.67，95% CI 0.47-0.93）以及住院时间1.94天（95% CI为- 3到- 0.87）。 免疫营养与术后并发症有关。围手术期给药可能是减少感染并发症、吻合口漏、SSI和住院时间的首选策略。 ©2023年。外科肿瘤学会。

Immunonutrition (IMN) in gastrointestinal (GI) cancer surgery remains under-utilised and contentious. Despite previous meta-analysis reporting benefit, most recent randomised control trials (RCTs) have failed to demonstrate this and have recommended against its routine use. A contemporary meta-analysis may contribute to the recommendations for immunonutrition use and help select which patients may benefit. The objective of this study was to review IMN and its impact on post-operative outcomes in GI cancer surgery, exploring its role in both malnourished and non-malnourished populations, the optimal dose to use, cancer type of patients using IMN and the timing of IMN relative to the peri-operative period.The EMBASE and Medline databases were searched from 2000 to 2022 for RCTs evaluating IMN in adults undergoing GI cancer surgery.Thirty-seven studies were included (22 pre-operative IMN studies, 11 peri-operative IMN trials and 9 post-operative IMN trials; 4 trials had multiple IMN protocols) that reported on 3793 patients. The main outcome of post-operative infectious complications was reduced with IMN [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.47-0.72]. This association was significant in subgroup analysis only with pre-operative and peri-operative administration and in trials including upper GI cancers, colorectal cancer and 'mixed GI' cancer populations, and significance was independent of nutritional status. IMN in pooled analysis reduced surgical site infection (SSI) (OR 0.65, 95% CI 0.52-0.81), anastomotic leak (OR 0.67, 95% CI 0.47-0.93) and length of stay (LOS) by 1.94 days (95% CI - 3 to - 0.87).Immunonutrition was associated with reduced post-operative complications. Peri-operative administration may be the preferred strategy in reducing infectious complications, anastomotic leak, SSI and LOS.© 2023. Society of Surgical Oncology.