Design: Open-label randomised trial
Population: 60 patients awaiting colorectal cancer surgery
Primary outcome: Postoperative morbidity (Clavien-Dindo, Comprehensive Complication Index)
Effect: Morbidity 50% vs 40%; CCI 15.7 vs 14.8 (no significant difference)

This open-label randomised trial gave 60 patients awaiting colorectal cancer surgery either immunonutrition or standard oral supplements as part of prehabilitation. Complications were graded by Clavien-Dindo and the Comprehensive Complication Index, and CT measured muscle before and after surgery.

Overall morbidity was 40% with standard supplements and 50% with immunonutrition, with no significant difference. The Comprehensive Complication Index was similar (14.8 vs 15.7), as were major complications. The immunonutrition group was older at baseline.

In exploratory analyses, handgrip strength and CT muscle measures fell with standard supplements and held steady with immunonutrition. These were secondary findings in a small trial.

This does not support paying more for immunonutrition to reduce complications. The muscle signal is a question for a larger trial, not a reason to change prescribing.

Morbidity was 40% with standard supplements and 50% with immunonutrition — no significant difference.
Major complications were similar between groups.
Muscle mass and grip strength were better preserved with immunonutrition in exploratory analyses.
Keep standard oral supplements as the default in prehabilitation unless a trial says otherwise.
Screen for malnutrition before colorectal surgery whichever supplement you use.

Why it matters

Immunonutrition is often added to prehabilitation at extra cost on the assumption that it lowers complications.

The statistics, in plain English

With 30 patients per arm, the trial could miss a modest benefit, but the point estimate went the wrong way for immunonutrition. The muscle findings come from secondary analyses and could be chance.