Clinical nutrition support has made great progress after nearly 30 years of research and practice. At present, the clinical effects of parenteral nutrition (PN) and enteral nutrition (EN) have been gradually confirmed by evidence-based medicine, and clinicians have a more comprehensive understanding of parenteral nutrition and enteral nutrition. Patients with progressive gastric cancer are mostly malnourished, and those who undergo total gastrectomy are generally in poor nutritional status due to the traumatic GI reconstruction surgery and long postoperative fasting time. Therefore, the implementation of reasonable nutritional support for these patients in the perioperative period is crucial to their smooth recovery. 1. Indications for nutritional support The Nutritional Risk Screening (NRS 2002) proposed by the European Society for Parenteral Enteral Nutrition (ESPEN) in 2002 was used to assess the nutritional risk of patients, and nutritional support was given to those with a score higher than 3. There is evidence that nutritional support 1-2 weeks before surgery reduces the incidence of postoperative infectious complications and improves patient prognosis. Nutritional support should be continued postoperatively in malnourished patients who have started receiving nutritional support preoperatively. Nutritional support should also be given to patients who still cannot resume normal diet 7-10 days after surgery due to complications. 2.Pre-operative nutritional support Since patients with gastric cancer have digestive tract dysfunction before surgery, pre-operative nutritional support should adopt enteral + parenteral nutritional support mode according to patients’ condition. 3.Perioperative nutritional support It is recommended to place a transabdominal wall jejunostomy tube during surgery. Although some multicenter randomized controlled studies have shown that early enteral nutrition after total gastrectomy can be started as early as 6 hours after surgery, the consensus reached by most centers and physicians is to start from 1-2 days after surgery. The dosage is gradually increased from postoperative day 1 and transitioned to total enteral nutrition in about 4-5 days. The input rate should be controlled at 20 ml/h at the beginning, and then it can be gradually increased, and the maintenance time is usually not less than 12 h. When adverse reactions (such as abdominal pain, vomiting, diarrhea, etc.) occur, the input rate should be promptly slowed down or interrupted, or even the enteral nutrition should be stopped. Because people recognize the importance of maintaining intestinal function, enteral nutrition has received due attention and reasonable application in many countries. In China, although many physicians are aware of the saying “enteral nutrition should be used when the intestine is functional”, in practice, there is still the phenomenon of misuse of parenteral nutrition. Blind TPN will increase the hospitalization cost and may lead to the increase of complication rate. In contrast, enteral nutrition is a more reasonable option in the early postoperative period. There is much compelling evidence that enteral nutrition and TPN have similar effects on improving postoperative regression and reducing the incidence of infectious complications after gastrointestinal surgery. Total gastrectomy patients tolerate early enteral feeding (EEF) well, with only minor and reversible complications. Even in the early postoperative period, when intestinal function has not been restored, enteral nutrition can be the preferred route of postoperative nutritional support for these patients. 4.Immunonutrition support In recent years, studies on the correlation between post-traumatic nutritional and metabolic support and immune response have shown that despite adequate parenteral or enteral nutrition given to post-traumatic patients, the cellular and humoral immune responses of patients are still relatively delayed. The addition of some immune-enhancing nutrients (e.g., glutamine dipeptide, arginine, and omega-3 polyunsaturated fatty acids) significantly improved the regression of patients with gastric cancer who underwent total gastrectomy, including shorter hospital stays, lower medical costs, and fewer postoperative infectious complications. Therefore, nutritional support with the addition of immune-enhancing nutrients has promising applications for post-trauma, especially for patients with post-operative oncology (e.g., progressive gastric cancer undergoing total gastrectomy).