Preoperative immunonutritional support for gastric cancer patients with low muscle mass diagnosed based on computed tomography: a prospective study.

Background: to explore the impact of short-term oral immunonutritional support before surgery on the short-term clinical outcomes of gastric cancer patients with low muscle mass. Methods: in this prospective controlled trial, 164 patients with low muscle mass scheduled for gastric cancer resection were randomized 1:1 to either an immunonutrition group (IN, n = 82) receiving a specific immunomodulatory formula (Suyuansu) or a standard nutrition group (SN, n = 82) receiving an isocaloric/isointrogenous whole-protein formula (Nengquan) for seven days preoperatively. The primary endpoint was the incidence of Clavien-Dindo grade ≥ IIIa complications within 30 days. Results: the incidence of severe postoperative complications was significantly reduced in the IN group compared with the SN group (7.3 % [6/82] vs 18.3 % [15/82], p = 0.035). The postoperative recovery time of the IN group was significantly shorter than that of the SN group (median: 9.0 days vs 10.0 days, p = 0.038), and the postoperative systemic inflammatory response intensity (area under the curve [AUC] of C-reactive protein [CRP]) was significantly lower than that of the SN group (p < 0.001). There was no statistically significant difference in the incidence of infectious complications between the two groups (13.4 % vs 20.7 %, p = 0.213). Conclusion: for gastric cancer patients with low muscle mass, short-term oral immunonutritional support before surgery can significantly reduce the risk of severe postoperative complications, alleviate systemic inflammatory responses, and accelerate postoperative recovery. It is a valid perioperative management strategy.