The Role of Omega-3 Polyunsaturated Fatty Acid Supplementation in Postoperative Recovery of Colorectal Cancer: Systematic Review and Meta-Analysis.

Omega-3 PUFA supplementation significantly increased nutritional markers in postoperative CRC patients compared to controls.

• 34 RCTs with a total of 2889 patients were included in the meta-analysis.
• Total protein levels were significantly higher in the omega-3 PUFA group (p < 0.00001).
• Albumin levels were significantly higher in the omega-3 PUFA group (p = 0.001).
• Serum omega-3 PUFA concentrations were also significantly increased (p = 0.0004).

Omega-3 PUFA supplementation significantly enhanced immunological parameters in postoperative CRC patients.

• CD3+, CD4+, and CD8+ T-cell counts were all significantly increased in the omega-3 PUFA group (all p < 0.0001).
• The CD4+/CD8+ ratio was also significantly improved (p < 0.0001).
• Karnofsky Performance Status (KPS) scores were significantly higher in the omega-3 PUFA group (p = 0.04).
• No significant intergroup differences were detected for white blood cells or transcription factor activity (p = 0.06–0.55).

Omega-3 PUFA supplementation significantly reduced postoperative inflammatory markers in CRC patients.

• Significant reductions were observed in procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α).
• P-values for inflammatory marker reductions ranged from p = 0.004 to p < 0.00001.
• The systematic search was conducted across major databases up to June 16, 2025, in accordance with PRISMA guidelines.
• Data were analyzed using RevMan v5.4 (Cochrane Collaboration).

Omega-3 PUFA supplementation significantly reduced clinical complication rates and hospitalization duration in postoperative CRC patients.

• Hospitalization duration was significantly shorter in the omega-3 PUFA group (p < 0.00001).
• Infectious complications were significantly reduced (p < 0.00001).
• Anastomotic leakage was significantly reduced (p = 0.0005).
• Surgical site infections were significantly reduced (p = 0.03).
• No significant difference in mortality was detected between groups (p = 0.06–0.55).

No significant differences were observed between omega-3 PUFA and control groups for several clinical and biological outcomes.

• White blood cell counts showed no significant intergroup difference (p = 0.06–0.55).
• Transcription factor activity showed no significant intergroup difference (p = 0.06–0.55).
• Mortality showed no significant intergroup difference (p = 0.06–0.55).
• Crypt cell proliferation indices showed no significant intergroup difference (p = 0.06–0.55).

A post hoc dose-response analysis identified a potentially optimal omega-3 PUFA supplementation range for Chinese CRC populations.

• The identified potentially optimal supplementation range was 0.16–0.30 g/kg/day.
• This range was identified specifically in the context of Chinese CRC populations.
• The findings are intended to provide foundational evidence for clinical practice and Food for Special Medical Purposes (FSMP) standardization in China.
• China is currently developing FSMP standards targeting oncology patients, and defining optimal omega-3 PUFA fortification levels was identified as a substantial challenge.