Introduction: Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as a potential strategy to improve surgical outcomes by reducing complications, enhancing immune function, and promoting recovery. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted on 28 October 2024 in accordance with PRISMA guidelines. Systematic reviews and meta-analyses evaluating perioperative IMN versus standard care in adult patients undergoing GI cancer surgery were included in the search. The outcomes assessed included infectious and non-infectious complications, wound healing, hospital stay, and nutritional status. The study quality was evaluated using AMSTAR 2, and the meta-analysis was conducted using random-effects models to calculate the pooled effect sizes (risk ratios [RRs], odds ratios [ORs], mean differences [MDs]) with 95% confidence intervals (CIs). Results: Sixteen systematic reviews and meta-analyses, including a total of 41,072 patients, were included. IMN significantly reduced infectious complications (RR: 0.62, 95% CI: 0.55–0.70; I² = 63.0%), including urinary tract infections (RR: 0.74, 95% CI: 0.61–0.89; I² = 0.0%) and wound infections (OR: 0.64, 95% CI: 0.55–0.73; I² = 34.4%). Anastomotic leak rates were notably lower (RR: 0.68, 95% CI: 0.62–0.75; I² = 8.2%). While no significant reduction in pneumonia risk was observed, non-infectious complications decreased significantly (RR: 0.83, 95% CI: 0.75–0.92; I² = 30.6%). IMN also reduced the length of hospital stay by an average of 1.92 days (MD: −1.92, 95% CI: −2.36 to −1.48; I² = 73.5%). Conclusions: IMN provides significant benefits in GI cancer surgery, reducing complications and improving recovery. However, variability in protocols and populations highlight the need for standardization and further high-quality trials to optimize its application and to validate its efficacy in enhancing surgical care.

Introduction: Robotic-assisted minimally invasive gastrectomy (RAMIG) rep- resents a significant advancement in the surgical management of gastric cancer, offering superior dexterity, enhanced visualization, and improved ergonomics compared to lapa- roscopic gastrectomy (LG). This review systematically evaluates the current evidence on perioperative outcomes, oncological efficacy, learning curves, and economic considera- tions, providing insights into RAMIG’s potential role in modern gastric cancer surgery. Methods: A thorough analysis of retrospective, prospective, and meta-analytic studies was conducted to compare RAMIG with LG. Key outcomes, including operative time, in- traoperative blood loss, lymph node retrieval, postoperative complications, learning curve duration, and cost-effectiveness, were assessed. Emphasis was placed on both short- term and long-term oncological outcomes to determine the clinical value of RAMIG. Re- sults: Evidence indicates that RAMIG is associated with reduced intraoperative blood loss, lower morbidity rates, and a shorter learning curve, with proficiency achieved after 11–25 cases compared to 40–60 cases for LG. The robotic platform’s articulated instru- ments and enhanced three-dimensional visualization enable more precise lymphadenec- tomy, particularly in complex anatomical regions. Despite these advantages, operative time remains longer, and costs remain higher due to system acquisition, maintenance, and consumable expenses. However, emerging data suggest a gradual narrowing of cost dis- parities. While short-term outcomes are favorable, further high-quality, multicenter stud- ies are needed to validate long-term oncological efficacy and survival outcomes. Conclu- sion: RAMIG offers significant technical and clinical advantages over conventional LG, particularly in terms of precision and learning efficiency. However, the long-term onco- logical benefits and economic feasibility require further validation. Future research should focus on cost optimization, advanced technological integration such as near-infrared flu- orescence and artificial intelligence, and multicenter trials to solidify RAMIG’s role as a standard approach for gastric cancer surgery.