Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes

Pietro Achilli, Michele Mazzola, Camillo Leonardo Bertoglio, Carmelo Magistro, Matteo Origi, Pietro Carnevali, Federico Gervasi, Carmen Mastellone, Nicoletta Guanziroli, Ettore Corradi, Giovanni Ferrari

Research output: Contribution to journalArticlepeer-review


Purpose: The aim of this study is to evaluate whether preoperative immunonutrition can shorten length of stay and improve postoperative outcomes in frail patients who are candidates for major oncologic colorectal surgery. Methods: A single center retrospective analysis of a prospectively collected database of frail patients, who underwent surgery with curative intent for colorectal cancer between January 2014 and December 2017, was performed. From March 2016, frail oncological patients undergoing major surgery were recommended to receive preoperative immunonutrition; their postoperative outcomes were compared to those of patients not treated with any preoperative nutritional support. Propensity score matching in a 1:1 ratio was used to balance patient characteristics. Results: Overall, 175 patients were included in the study. Of 74 patients receiving immunonutrition, 65 were matched with the group not treated with immunonutrition (n = 101). Baseline characteristics were comparable after matching. Although differences in postoperative length of stay were nonsignificant (p = 0.38), patients who received immunonutrition showed a shorter gastrointestinal (GI) recovery time (3.00 [2.00–4.00] versus 4.00 [2.00–5.00], p = 0.04), a lower rate of situs site infections complications (0.31 [0.10, 0.94], p = 0.04) and less need of antibiotic treatment (0.19 [0.06, 0.64], p = 0.01). Conclusion: Preoperative immunonutrition was found to reduce both postoperative situs site infections and need of antibiotic treatment during the postoperative course. This study encourages the use of preoperative immune-enhancing nutrition as a part of multimodal prehabilitation programs in the management of frail colorectal cancer patients.

Original languageEnglish
Pages (from-to)19-27
Number of pages9
JournalInternational Journal of Colorectal Disease
Issue number1
Publication statusPublished - Jan 1 2020
Externally publishedYes


  • Colorectal cancer
  • Frailty
  • Immunonutrition
  • Length of stay
  • Postoperative complications

ASJC Scopus subject areas

  • Gastroenterology


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