ImmunoNutrition and Colorectal Adenocarcinoma Surgery - INCAS Study

Not Applicable

Recruiting

• Conditions: Colorectal Adenocarcinoma
• Interventions: Dietary Supplement: Impact Oral®

• Registration Number: NCT06134440
• Lead Sponsor: Istituto Oncologico Veneto IRCCS

Brief Summary

Compared to upper gastrointestinal (GI) malignancies, CRC patients generally present with satisfactory nutritional status at surgery and malnutrition is typically present in advanced stages of CRC. Therefore, in the latter surgery may not be offered with curative intent. Based on the current evidence, the role of OIN appears to be consolidated for malnourished patients undergoing surgery for gastrointestinal cancer. Regarding not malnourished patients, there is still no clear correlation between OIN and decrease in post-operative complications. Furthermore, whether OIN increases immune response within the tumour microenvironment is based on studies with poor number of patients.

Detailed Description

Randomized, controlled, open-label, single-centre study in patients candidate for elective curative surgery for colon-rectal cancer.

The study intervention consists of the oral nutritional supplementation enriched with immune-nutrients delivered before and after surgery in addition to standard dietary advice according to E.R.A.S. protocol.

All patients will follow low-fiber diet according to ERAS protocol during the study period. Patients assigned to the experimental arm will assume also Impact Oral®, an oral nutritional supplement with immune-nutrients (hyper-proteic formula), manufactured and commercialized by Nestlé Health Science S.p.a. It is a liquid drink packaged in a brick of 237 ml. Patients will assume Impact Oral® for 5 days before surgery and 5 day after surgery.

Study Timeline

• Study First Submitted: 2023-11-07
• Study First Submitted QC: 2023-11-10
• Study First Posted: 2023-11-18
• Study Start: 2023-11-21
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-10
• Last Update Posted: 2025-01-13
• Primary Completion: 2025-09
• Study Completion: 2025-09

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 200

Inclusion Criteria

• Patients aged ≥ 18 years or older;
• histologically confirmed adenocarcinoma of colon or rectum;
• Eligible for elective curative surgery with indication of colon and/or rectal resection in laparoscopy with mini-invasive technique;
• eligible for ERAS protocol;
• Written informed consent to the study participation according to the Local Ethic Committee requirements before any study procedure;

Exclusion Criteria

• colon or rectal resection for benign disease;
• TNM Stage ≥4;
• neoadjuvant radio and/or chemotherapy
• ASA score > 3;
• contraindications to oral nutrition (e.g. dysphagia, pyloric stenosis) or hypersensitivity to any ingredient of study product;
• albuminemia < 3.0 g/l;
• weight loss > 10% in the last 3-6 months;
• BMI < 18.5 kg/m2;
• pregnant or breastfeeding;
• Not self-sufficient or with poor family compliance;
• Congenital or acquired immunodeficiency;
• Active uncontrolled pre-operative infections or other clinically relevant concomitant illness that preclude laparoscopic procedure;
• Bowel obstruction or parenteral nutrition or gastric tube;

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A (interventional arm)	Impact Oral®	a low-fiber dietary advice + oral nutritional supplement enriched with immune-nutrients for 5 pre-operative days and 5 post-operative days.

Primary Outcome Measures

Name	Time	Method
Primary Outcome Measure - Number of patients with grade 2 or higher post-operative complications	within 30 days post-surgical intervention	Number of patients with grade 2 or higher post-operative complications according to Clavien-Dindo classification occurred within 30 days post-surgical intervention.

Secondary Outcome Measures

Name	Time	Method
Secondary Outcome Measure - Hospital length of stay	From the day of surgery until discharge, assessed up to 7 days	Hospital length of stay defined as hospitalization from the day of surgery until discharge
Secondary Outcome Measure - Safety assessed according to CTCAE	From admission to discharge, assessed up to 42 days	Safety assessed according to criteria to NCI Common Toxicity Criteria Adverse Event (CTCAE), version 5
Secondary Outcome Measure - Nutritional status before and after surgery	differences at day 1, 3, 5, 15 and 30 after surgery from T0 (7-10 days before surgery) will be calculated and compared between the two arms	Nutritional status before and after surgery will be assessed evaluating albumin, prealbumin and transferrin serum levels: differences at day 1, 3, 5, 15 and 30 after surgery from T0 (7-10 days before surgery) will be calculated and compared between the two arms
Secondary Outcome Measure - 30-day mortality for any cause	30-day mortality for any cause	30-day mortality for any cause
Secondary Outcome Measure - Inflammatory status before and after surgery	differences at day 1, 3, 5, 15 and 30 after surgery from T0 (7-10 days before surgery) will be calculated and compared between the two arms	Inflammatory status before and after surgery will be assessed evaluating leukocytes (x10\^(9)/L), C-reactive protein (PCR) (mg/dL), procalcitonin (ug/L), neutrophil-lymphocyte (ratio), and lactate dehydrogenase (LDH) serum levels (U/L).; The haematic quantification of this biomarkers provides information about the inflammatory status.
Secondary Outcome Measure - Reoperation rate	within 30 days following the index surgery	Reoperation rate within 30 days from index surgery defined as any unplanned post-operative procedure including a return in the operating room or an imaging-guided intervention within 30 days following the index surgery
Secondary Outcome Measure - Unplanned readmissions	within 30 days from discharge	Unplanned readmissions within 30 days from discharge

Trial Locations

Locations (1)

Istituto Oncologico Veneto IRCCS; 🇮🇹 Padova, Italy