The meta-analysis by Adiamah et al. (1) clearly identifies the value of preoperative feeding with immune modulating nutrition(IMN) preoperatively in patients undergoing surgery for gastrointestinal cancer sufficient to make this a general recommendation by the relevant nutrition societies such as in future ESPEN and the Society of Critical Care Medicine-ASPEN guidelines (2,3). Previously ESPEN has recommended IMN in malnourished patients following major cancer surgery (2,4), but there has been some controversy as to whether IMN offered benefit beyond that seen with standard supplemental feeding in preoperative patients (5). However this present analysis appears to firmly establish the value of IMN in preoperative preparation of the gastrointestinal cancer patient undergoing surgery. That said there are significant and important characteristics of their analysis of 16 randomized trials of solely preoperative feeding in patients with gastrointestinal cancer that may have been critical in determining the significant outcomes of a marked reduction in infectious complications by nearly 1/2 (OR=0.52) with a P＜0.0001 and length of hospital stay by 1.57 days (-2.48 to -0.66) with a P value＜0.0007. Interestingly there was no impact on non-infectious complications, which might be anticipated, since enhancement of immune function would be expected to principally impact on the risk of infectious complications which could then secondarily influence length of stay. First the authors restricted the included studies to have only those patients with malignant disease with the preoperative feeding period to be at least 3 days, which included studies up to a total of 8 days duration. The former restriction tends to identify a group most likely to benefit from immune enhancement, and the latter trial condition reflects