PeRioperative Optimization With Nutritional Supplements for Patients Undergoing GastRointEStinal Surgery for Cancer

Not Applicable

Completed

• Conditions: Gastrointestinal Cancer
• Interventions: Other: Nutritional Supplements; Other: Placebo

• Registration Number: NCT03445260
• Lead Sponsor: Hamilton Health Sciences Corporation

Brief Summary

This is a single-center randomized, placebo-controlled, double-blind feasibility study comparing the intervention of perioperative nutritional supplements (immunomodulation, carbohydrate loading, and protein isolate) with an identical placebo for each solution in patients with gastrointestinal cancer undergoing surgery. Eligible and consenting patients will be randomly allocated to receive the intervention or placebo in a 1:1 ratio.

This study will assess the feasibility of a large, multi-centre trial by establishing the feasibility of randomization to intervention or placebo. This study will be conducted at the Juravinski Hospital and will enroll 100 patients over 18 months.

The study intervention includes three perioperative nutritional supplements: (1) a protein supplement administered 3 times a day for 30 days before surgery, (2) a sugar-based supplement administered the day prior to and the day of surgery, and (3) a formulated liquid diet containing arginine, RNA, proteins and omega-6 fatty acids (referred to as immunonutrition for the purposes of this study) administered for 5 days prior to and 5 days after surgery.

The primary outcome for each eligible patient is defined as being randomized to intervention or placebo. The criteria for success of this study is defined as the proportion of eligible patients randomized as ≥ 60%. If the estimated proportion is \<40%, the trial will be considered not feasible. If the proportion is between 40%-59%, the trial will be considered feasible with modifications to improve enrolment. Other secondary objectives include compliance with study intervention, estimating differences in postoperative complications, length of hospital stay, and quality of life between groups.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2017-12-21
• Study First Submitted QC: 2018-02-22
• Study First Posted: 2018-02-26
• Study Start: 2018-10-17
• Primary Completion: 2020-07-22
• Study Completion: 2020-08-30
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-01
• Last Update Posted: 2021-09-02

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 73

Inclusion Criteria

• Men and women 18 years of age or older
• Diagnosed with a resectable type of gastrointestinal cancer (e.g. cancers of the gallbladder, liver, pancreas, stomach, small intestine, colon and rectum) for which an elective operation is planned (resection vs. palliative procedure).
• Patients with distant metastasis are eligible for the study.
• Patients who are lactose intolerant are also eligible for the study because the amount of lactose in ISOlution and PreCovery is minimal (trace).

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Exclusion Criteria

• Malabsorption syndrome (e.g. chronic pancreatitis)
• Cannot tolerate oral intake (e.g. gastric outlet obstruction or delayed gastric emptying)
• Organ failure (liver, kidney); end stage liver disease with a Child Pugh Score ≥ B or end stage renal disease defined as stages 3 and 4 with a glomerular filtration rate between 30-59 for stage 3 and 15-29 for stage 4.
• Inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematous, Crohn's disease and ulcerative colitis
• Patients currently on steroids
• Poorly controlled type 1 or 2 diabetes mellitus
• Female patients who are pregnant and/or lactating
• Galactosemia
• Ongoing infection.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Nutritional Supplements	Nutritional Supplements	carbohydrate loading, immunonutrition (formulated liquid diet), protein supplement
Placebo	Placebo	Each placebo is composed of a collagen-based filler with exactly the same taste and texture as the intervention.

Primary Outcome Measures

Name	Time	Method
The number of patients randomized to the study	21 months	Feasibility of this study will be determined by the number of eligible patients randomized to intervention or placebo.

Secondary Outcome Measures

Name	Time	Method
Length of Hospital Stay	1 month after index surgery	Will be determined for each patient.
Comprehensive Complication Index	3 months after index surgery	At 90 days from the index operation will be determined for each patient. This index can be calculated for each patient using the online calculator www.assessurgery.com25 following the grading of each postoperative complication according to Clavien-Dindo.
The number of patients who comply with the study intervention regimen	30 days before index surgery, and up to 5 days after index surgery	Compliance will be defined as intake of at least 70% of study intervention regimen.
Overall Complications	3 months after index surgery	Occurrence of any postoperative complication (major or minor) from surgery following each patient's hospital stay and up to 90 days from the initial operation. Occurrence of any postoperative infections will also be calculated.
Quality of Life (QoL) - EORTC-QLQ-C Instrument	Baseline, 1 month, and 3 months after index surgery	The global health related QoL at baseline, 1 and 3 months following randomization measured using the EORTC-QLQ-C instrument.
Quality of Life (QoL) - FACT-G Scale	Baseline, 1 month, and 3 months after index surgery	The global health related QoL at baseline, 1 and 3 months following randomization measured using the FACT-G scale.

Trial Locations

Locations (1)

Hamilton Health Sciences; 🇨🇦 Hamilton, Ontario, Canada