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AIM: To investigate the potential role of perioperative nutrition in reducing complications and mortality in malnourished gastrointestinal cancer patients.METHODS:Four hundred and sixty-eight elective moderately or severely malnourished surgical patients with gastric or colorectal cancers defined by the subjective global assessment (SGA) were randomly assigned to 7 d preoperative and 7 d postoperative parenteral or enteral nutrition vs a simple control group.The nutrition regimen included 24.6±5.2 kcal /kg per d non-protein and 0.23±0.04 g nitrogen /kg per d.Control patients did not receive preoperative nutrition but received 600±100 kcal non-protein plus or not plus 62±16 g crystalline amino acids postoperatively.RESULTS: Complications occurred in 18.3% of the patients receiving nutrition and in 33.5% of the control patients (P= 0.012). Fourteen patients died in the control group and 5 in those receiving nutrition. There were significant differences in the mortality between the two groups (2.1% vs 6.0%, P=0.003). The total length of hospitalization and postoperative stay of control patients were significantly longer (29 vs 22 d, P=0.014) than those of the studied patients (23 vs 12 d, P= 0.000).CONCLUSION: Perioperative nutrition support is beneficial for moderately or severely malnourished gastrointestinal cancer patients and can reduce surgical complications and mortality.