Effects of preoperative oral carbohydrate loading on postoperative outcomes and change in neutrophil/lymphocyte ratio and following elective colorectal cancer surgery : A randomized controlled study

Title:

Effects of Preoperative Oral Carbohydrate Loading on Postoperative Outcomes and Change in Neutrophil/Lymphocyte Ratio Following Elective Colorectal Cancer Surgery: A Randomized Controlled Study.

Study Overview:

This randomized controlled trial (RCT) investigates the effects of preoperative oral carbohydrate loading (CHO) on postoperative outcomes and changes in the neutrophil/lymphocyte ratio (NLR) in colorectal cancer (CRC) patients undergoing elective surgery.

Background & Rationale:

CRC is a leading cause of cancer-related deaths.

Prolonged fasting before surgery triggers inflammatory responses, affecting patient recovery.

CHO loading, part of Enhanced Recovery After Surgery (ERAS) protocol, may reduce post-surgical complications and improve immune response.

• Change in NLR can serve as an inexpensive hematological marker to predict postoperative recovery and complications.

Objectives:

1. Primary:

Compare postoperative complications (classified by Clavien-Dindo scale) between CHO-loaded and fasting groups.

Investigate the impact on complications such as wound infections, pneumonia, ileus, renal failure, septic shock, and MODS.

2. Secondary:

Compare change in NRL between groups.

Assess the time to discharge based on criteria such as return of bowel function, tolerance to diet, pain management, and absence of infections.

Study Design:

Type: Randomized Controlled Trial (RCT).

Sample Size: 68 patients (34 in each group).

Study Groups:

Control: Conventional preoperative fasting.

Intervention: CHO group receives maltodextrin drink (400ml night before and 200ml 2 hours before surgery).

Randomization: Block randomization with concealed allocation.

Blinding: Not involved.

Methodology:

1. Preoperative assessment includes demographic data and baseline NLR.

2. Both groups undergo standard preoperative treatments.

3. Postoperative complications monitored for 30 days.

4. NLR measured on postoperative days 1, 3, and 5.

5. Time to discharge evaluated using standardized criteria.

Statistical Analysis:

Continuous variables: Mean/Median (Student’s t-test/Mann-Whitney test).

Categorical variables: Chi-square/Fisher’s exact test.

Multivariable analysis for risk assessment.

Expected Outcomes:

CHO loading is hypothesized to reduce complications and improve postoperative recovery.

Lower change in NRL in the CHO group suggests reduced systemic inflammation.

Shorter hospital stay and fewer severe complications expected in the intervention group.

Ethical Considerations:

Risks include multiple venous samplings.

Precautions taken for potential adverse effects.

Conclusion:

This study aims to establish CHO loading as a cost-effective and beneficial intervention in colorectal cancer surgery by assessing its impact on complications, inflammation, and hospital stay duration.