The impact of nutritional intervention on postoperative prognosis in gynecological cancer patients: a systematic review and meta-analysis
Gynecological cancers present a major global health challenge, with malnutrition recognized as a significant factor worsening prognosis. Extensive surgical procedures and chemotherapy often compromise nutritional status, leading to delayed recovery and poor outcomes. This review aimed to assess the role of nutritional interventions in improving postoperative prognosis among gynecological cancer patients. Following PRISMA guidelines, PubMed, ScienceDirect, and Google Scholar were searched up to August 2025. Eligible randomized trials, cohort, and feasibility studies evaluated nutritional interventions, including early oral feeding, oral supplements, parenteral nutrition, prehabilitation, coffee, and gum chewing. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I. Data were narratively synthesized, with random-effects meta-analysis performed where appropriate. This study has been registered with PROSPERO (CRD420251071481). A total of 13 studies (randomized and observational) were included. Pooled analyses showed no overall difference in hospital stay between nutritional interventions and standard care (MD -0.56 days; 95% CI -1.34 to 0.22), though subgroup analysis revealed that early oral feeding (EOF), coffee, and gum chewing significantly shortened hospitalization, while total parenteral nutrition (TPN) prolonged it. Nutritional interventions did not significantly reduce postoperative complications overall (OR 0.85; 95% CI 0.55-1.32), but EOF and gum chewing lowered infective and ileus-related morbidity in some studies. Gastrointestinal recovery was consistently accelerated with EOF, coffee, and gum chewing, whereas TPN delayed recovery. Oral nutritional supplements (ONS) improved nutritional indices, and prehabilitation shortened the time to chemotherapy. Survival outcomes were rarely reported, with malnutrition predicting poor prognosis. Overall, interventions were safe and well-tolerated. Nutritional interventions, particularly EOF, coffee, gum chewing, and ONS, enhance recovery and nutritional status in gynecologic oncology, whereas TPN should be reserved for selected malnourished patients.