Immunonutrition provides the strongest evidence for perioperative immune homeostasis in gastrointestinal cancer surgeryNew Strategies May Improve Recovery After Gastrointestinal Cancer Surgery

Surgical injury compresses tissue damage, neuroendocrine stress, pain, fasting, microbial exposure, and repair into a brief interval of intense immune activity. Although anesthetic, analgesic, and nutritional care are usually examined separately, each can affect cytokine release, immune-cell trafficking, oxidative stress, macrophage activity, gut barrier integrity, substrate availability, and inflammatory resolution. This mini review examines the mechanistic and clinical evidence linking anesthetic technique, regional and opioid-sparing analgesia, anti-inflammatory adjuncts, and immunonutrition with perioperative immune homeostasis, focusing on major gastrointestinal and cancer surgery. Current evidence indicates that anesthetic and analgesic strategies can alter inflammatory or immune-cell phenotypes, and these changes are most informative when interpreted as surrogate or mechanistic endpoints linked to patient-important outcomes. Immunonutrition has the clearest clinical evidence in gastrointestinal cancer surgery, particularly among nutritionally vulnerable or high-risk patients, although effects vary with formula composition, timing, route, adherence, procedure, and comparator. Direct trials of integrated anesthesia-analgesia-immunonutrition pathways are now needed to connect these mechanistic pathways with recovery outcomes. Risk-stratified studies can use this framework to examine both component-specific effects and interactions across the wider pathway.