Standard and Immunostimulating Enteral Nutrition in Surgical Patients

NCT ID: NCT00576940

Last Updated: 2007-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

196 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-06-30

Study Completion Date

2007-09-30

Brief Summary

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The aim of the study was to assess the clinical effect of immunomodulating enteral nutrition in patients undergoing resection for gastrointestinal cancer. 196 subjects were randomly assigned into two study groups: standard and immunostimulating. The study failed to demonstrate any clear advantage of routine postoperative immunonutrition in patients undergoing elective upper gastrointestinal surgery

Detailed Description

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Background\&Aim: The administration of immunomodulating enteral diets during postoperative period in patients after major gastrointestinal surgery is intended to reduce the number of postoperative complications and to shorten the hospital stay. The aim of the study was to assess the clinical effect of enteral immunostimulatory nutrition in surgical patients.

Material and Methods: 196 patients undergoing resection for pancreatic and gastric cancer were randomized in double-blind manner to receive early postoperative enteral nutrition with immunostimulating diet (IMEN group: formula supplemented with arginine, glutamine, omega-3 fatty acids) or oligopeptic control (SEN group) between June 2004 and September 2007. Enteral nutrition was started 6 hours after surgery and continued for 7 days, up to target volume of 100 ml/h. All malnourished patients requiring preoperative nutritional therapy were excluded for the study and treated preoperatively. Outcome measures were: number and type of complications, length of hospital stay, mortality, treatment tolerance, liver and kidney function.

Results: One hundred eighty-three patients (91 in SEN, 92 in IMEN group, 69 F, 114 M, mean age 61.2) of 196 initially enrolled were analyzed. There were 2 deaths in both groups. Median postoperative hospital stay was 12.4 days (SD 5.9) in SEN group and 12.9 days (SD 8.0) in IMEN group (p=0.42). Complications were observed in 21 patients (23.1%) in SEN and 23 (25.2%) in IMEN group (p\>0.05). 4 (4.4%) patients in SEN group and 4 (4.4%) in IMEN had surgical complications (p\>0.05). There were no differences in liver and kidney function, visceral protein concentration and treatment tolerance.

Conclusion: Clinical and laboratory parameters show no benefit of immunomodulating enteral nutrition over standard enteral nutrition in patients after major gastrointestinal surgery as far as complications, hospital stay, mortality and treatment tolerance and safety are considered.

Conditions

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Gastric Cancer Pancreatic Cancer

Keywords

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enteral nutrition, immunomodulating nutrition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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IMEN: 1

Enteral nutrition with immunostimulating diet (IMEN group: formula supplemented with arginine, glutamine, omega-3 fatty acids)

Group Type EXPERIMENTAL

Reconvan

Intervention Type DRUG

isocaloric, immunomodulating entral diet

SEN

postoperative enteral nutrition - standard oligopeptic diet

Group Type ACTIVE_COMPARATOR

Peptisorb

Intervention Type DRUG

isocaloric, isopeptic standard diet

Interventions

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Reconvan

isocaloric, immunomodulating entral diet

Intervention Type DRUG

Peptisorb

isocaloric, isopeptic standard diet

Intervention Type DRUG

Other Intervention Names

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oligopeptic immunostimulatory diet standard enetral diet

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18-80 years undergoing subtotal and total gastric resection with lymphadenectomy and pancreatoduodenectomy/ total pancreatectomy with lymphadenectomy, in good general status (Karnofsky \> 80, Eastern Cooperative Oncology Group (ECOG) grade 0 or 1); with no confirmed neoplastic dissemination nor distant metastases
* No severe concomitant disease (heart failure, chronic obstructive pulmonary disease \[COPD\], coronary aortic bypass graft \[CABG\], etc.)
* No history of known allergies or drug intolerance

Exclusion Criteria

* Patients with metastatic or unresectable disease
* Pregnant
* In poor general status (Karnofsky \<80, Eastern Cooperative Oncology Group (ECOG) \> 1)
* With recent history of severe heart, lung, kidney or liver failure
* With history of allergies or drug intolerance
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jagiellonian University

OTHER

Sponsor Role lead

Responsible Party

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Jagiellonian University

Principal Investigators

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Jan Kulig, MD, PhD

Role: STUDY_CHAIR

1st Department of General Surgery

Locations

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1st Deparment of General Surgery

Krakow, Krkaow, Poland

Site Status

Countries

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Poland

References

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Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional approach in malnourished surgical patients: a prospective randomized study. Arch Surg. 2002 Feb;137(2):174-80. doi: 10.1001/archsurg.137.2.174.

Reference Type RESULT
PMID: 11822956 (View on PubMed)

Klek S, Szybinski P, Szczepanek K. Perioperative immunonutrition in surgical cancer patients: a summary of a decade of research. World J Surg. 2014 Apr;38(4):803-12. doi: 10.1007/s00268-013-2323-z.

Reference Type DERIVED
PMID: 24178185 (View on PubMed)

Klek S, Sierzega M, Szybinski P, Szczepanek K, Scislo L, Walewska E, Kulig J. The immunomodulating enteral nutrition in malnourished surgical patients - a prospective, randomized, double-blind clinical trial. Clin Nutr. 2011 Jun;30(3):282-8. doi: 10.1016/j.clnu.2010.10.001. Epub 2010 Nov 13.

Reference Type DERIVED
PMID: 21074910 (View on PubMed)

Klek S, Kulig J, Sierzega M, Szczepanek K, Szybinski P, Scislo L, Walewska E, Kubisz A, Szczepanik AM. Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery--a prospective, randomized, controlled clinical trial. Clin Nutr. 2008 Aug;27(4):504-12. doi: 10.1016/j.clnu.2008.04.010. Epub 2008 Jun 20.

Reference Type DERIVED
PMID: 18571296 (View on PubMed)

Other Identifiers

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Immunoenteral

Identifier Type: -

Identifier Source: secondary_id

1st Dept Surg Enteral

Identifier Type: -

Identifier Source: org_study_id