Mazandaran Association of Emergency Medicine Translational Health Reports 3092-6750 2 1 2025 12 20 The Combined Impact of Preoperative Nutritional Support and Esketamine on Postoperative Recovery, Immune Function, and Quality of Life in Older Patients Receiving Thoracoscopic Lung Cancer Surgery 236686 10.22034/thr.2025.236686 EN Ismael Bilal Ismael College of Nursing, Hawler Medical University, Erbil, Kurdistan Region-Iraq. Sarwar Nawzad Jafar Department of Biology, College of Education, Salahaddin University-Erbil, Erbil, Kurdistan Region-Iraq. 0000-0002-9990-1065 Journal Article Background: Older patients undergoing thoracoscopic radical resection for lung cancer face considerable risks of postoperative pain, weakened immunity, and malnutrition, which can slow recovery. Multimodal approaches are needed to enhance results. This review explores the combined benefits of preoperative nutritional support and analgesia based on esketamine.<br>Methods: A narrative literature review was performed using databases including PubMed, Embase, and the Cochrane Library up to 2025. The search targeted clinical trials, randomized controlled trials (RCTs), and meta-analyses on esketamine, preoperative nutrition, and outcomes in thoracic or cancer surgery. Information was combined to assess impacts on pain relief, immune and nutritional indicators, and recovery measures.<br>Results: Research consistently shows that esketamine notably decreases postoperative pain scores and opioid use while reducing opioid-related side effects. Preoperative immunonutrition lessens the surgery-related drop in immune markers (IgG, IgM, IgA) and nutritional proteins (Alb, TRF, PAB). Together, these approaches work synergistically to speed gastrointestinal recovery, reduce hospital stay, and improve health-related quality of life scores in older surgical patients.<br>Conclusion: Incorporating preoperative nutritional support and esketamine into Enhanced Recovery After Surgery (ERAS) protocols offers a promising multimodal method to improve perioperative care. This approach effectively manages pain, supports immune and nutritional health, and encourages quicker recovery, supporting broader clinical use and additional large-scale RCTs. https://www.threports.com/article_236686_d559a39bbe9b928c6fe17c812e2cc9c0.pdf