Clinical evidence for post- and after surgery nutrition recommendations


Enhanced Recovery After Surgery (ERAS) framework


Here is a list of links to the clinical evidence, primarily guidelines and randomized controlled trials (RCTs), that were referenced for post- and after-surgery nutrition from PubMed.

I. Major Guidelines (Meta-Analysis of Evidence)

These documents synthesize the best available evidence (including RCTs and systematic reviews) into clinical recommendations, particularly within the Enhanced Recovery After Surgery (ERAS) framework.

  • ESPEN guideline on clinical nutrition in surgery - Update 2025

  • PMID: 40957230

  • DOI: 10.1016/j.clnu.2025.08.029

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/40957230/

  • ESPEN guideline: Clinical nutrition in surgery (Former Version)

  • PMID: 28385477

  • DOI: 10.1016/j.clnu.2017.02.013

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/28385477/

II. Randomized Controlled Trials (RCTs) & Key Comparisons

These studies provide the direct evidence for the efficacy of specific nutritional interventions.

  • A. Postoperative Oral Nutritional Supplements (ONS)

A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients

Finding: Postoperative ONS improved nutritional status, quality of life (QOL), and morbidity in malnourished surgical patients.

PMID: 10807893

DOI: 10.1136/gut.46.6.813

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/10807893/

  • Oral dietary supplements in pre- and postoperative surgical patients: a prospective and randomized clinical trial

Finding: Routine ODS offered no clinical or functional benefit in well-nourished patients undergoing major GI surgery. (Highlights the need to target at-risk patients).

PMID: 10978851

DOI: 10.1016/s0899-9007(00)00377-4

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/10978851/

  • B. Enteral vs. Parenteral Nutrition

Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial

Finding: Early enteral nutrition significantly reduced the complication rate and duration of postoperative stay compared with parenteral nutrition in malnourished GI cancer patients.

PMID: 11705560

DOI: 10.1016/S0140-6736(01)06578-3

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/11705560/

  • Postoperative enteral vs parenteral nutrition. A randomized controlled trial

Finding: Enteral nutrition provided by needle-catheter jejunostomy compared favorably with Total Parenteral Nutrition (TPN), providing adequate support with significant cost efficiency.

PMID: 3090978

DOI: 10.1001/archsurg.1986.01400090070011

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/3090978/

  • C. Timing of Oral Feeding (Early vs. Late)

Comparison of Clinical Outcomes and Postoperative Nutritional Status Between Early and Late Oral Feeding After Esophagectomy: An Open Labeled Randomized Controlled Trial

Finding: Late oral feeding (with jejunostomy tube support) led to significantly less body weight loss and higher total caloric and protein intake compared to an early oral feeding protocol after esophagectomy. (Note: The optimal timing is often context/surgery-dependent).

PMID: 38994579

DOI: 10.1097/SLA.0000000000006441

PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38994579/