ImmunoNutrition and Colorectal Adenocarcinoma Surgery - INCAS Study

Istituto Oncologico Veneto IRCCS71 enrolled

Overview

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.

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 Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Colorectal Adenocarcinoma

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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;

Outcomes

Primary Outcomes

Primary Outcome Measure - Number of patients with grade 2 or higher post-operative complications

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

Time frame: within 30 days post-surgical intervention

Secondary Outcomes

Secondary Outcome Measure - Hospital length of stay

Hospital length of stay defined as hospitalization from the day of surgery until discharge

Time frame: From the day of surgery until discharge, assessed up to 7 days

Secondary Outcome Measure - Reoperation rate

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

Time frame: within 30 days following the index surgery

Secondary Outcome Measure - Unplanned readmissions

Unplanned readmissions within 30 days from discharge

Time frame: within 30 days from discharge

Secondary Outcome Measure - 30-day mortality for any cause

30-day mortality for any cause

Time frame: 30-day mortality for any cause

Secondary Outcome Measure - Safety assessed according to CTCAE

Safety assessed according to criteria to NCI Common Toxicity Criteria Adverse Event (CTCAE), version 5

Time frame: From admission to discharge, assessed up to 42 days

Secondary Outcome Measure - Nutritional status before and after surgery

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

Time frame: 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 - Inflammatory status before and after surgery

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.