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Investigating the Use of a Preoperative High-Arginine Nutritional Supplement Prior to Radical Cystectomy

NCT ID: NCT02655081

Last Updated: 2017-10-03

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

PHASE2

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-07-31

Study Completion Date

2016-12-31

Brief Summary

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To provide patients with bladder cancer who are scheduled to undergo radical cystectomy with a preoperative high-arginine nutritional supplement. The investigator will measure patient adherence to the regimen, tolerability of the supplement and feasibility of supplementation. Secondary outcome measures will include differences in length of stay and complication rate between groups.

Detailed Description

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The purpose of this study is to investigate the use of a high-arginine protein supplement prior to surgery for patients undergoing radical cystectomy for treatment of bladder cancer. As many as 50% of patients who undergo radical cystectomy experience a postoperative complication, and poor preoperative nutritional status is known to increase the risk of complications. Preoperative use of a high-arginine protein shake has been shown to reduce the risk of postoperative complications for patients undergoing surgery for colon cancer, and this study seeks to determine whether this is also true for patients undergoing radical cystectomy for bladder cancer.

Subjects will drink four protein shakes (Nestle Impact AR) per day for 5-7 days prior to radical cystectomy. Shakes will be provided to patients free of charge. On the date of surgery, subjects will turn in a log of shake consumption. Surgery will then proceed in typical fashion, and no changes will be made to surgery or postoperative care. Clinical outcomes for the first 90 postoperative days will be collected. Patient outcomes will be compared to those of contemporary controls who do not undergo supervised nutritional supplementation. Primary study outcome is to assess safety, tolerability and adherence to supplementation regimen. Secondary outcomes include differences in complication rates and length of postoperative hospital stay between groups.

Conditions

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Bladder Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Dietary supplement

Subjects will receive high arginine nutritional supplement (Nestle's Impact AR), prior to cystectomy

Group Type EXPERIMENTAL

high arginine nutritional supplement (Nestle's Impact AR)

Intervention Type DIETARY_SUPPLEMENT

Preoperative High-Arginine Nutritional Supplement Prior to Radical Cystectomy

Interventions

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high arginine nutritional supplement (Nestle's Impact AR)

Preoperative High-Arginine Nutritional Supplement Prior to Radical Cystectomy

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Any adult patient seen at one of the aforementioned UPMC facilities who carries a diagnosis of bladder cancer and is considered a candidate for radical cystectomy for treatment.

Exclusion Criteria

* Minors \< 18 years of age, patients not considered surgical candidates, patients who do not go on to undergo radical cystectomy. Patients with Glomerular Filtration Rate (GFR) \< 30 will also be excluded in an attempt to limit protein intake of patients with Stage IV and V Chronic Kidney Disease. Diabetic patients will be allowed to participate.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Tatum Tarin, MD

Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tatum Tarin, MD

Role: PRINCIPAL_INVESTIGATOR

Associate Professor of Medicine

Locations

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Shadyside Urology

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

References

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Braga M, Gianotti L, Radaelli G, Vignali A, Mari G, Gentilini O, Di Carlo V. Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg. 1999 Apr;134(4):428-33. doi: 10.1001/archsurg.134.4.428.

Reference Type BACKGROUND
PMID: 10199318 (View on PubMed)

Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009 Jan;55(1):164-74. doi: 10.1016/j.eururo.2008.07.031. Epub 2008 Jul 18.

Reference Type BACKGROUND
PMID: 18675501 (View on PubMed)

Lee CT, Madii R, Daignault S, Dunn RL, Zhang Y, Montie JE, Wood DP Jr. Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol. 2006 Apr;175(4):1262-7; discussion 1267. doi: 10.1016/S0022-5347(05)00644-0.

Reference Type BACKGROUND
PMID: 16515975 (View on PubMed)

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999 Jan;134(1):36-42. doi: 10.1001/archsurg.134.1.36.

Reference Type BACKGROUND
PMID: 9927128 (View on PubMed)

Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, Davis R, Stimson CJ Jr, Aghazadeh M, Smith JA Jr, Barocas DA. Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol. 2011 Jan;185(1):90-6. doi: 10.1016/j.juro.2010.09.021. Epub 2010 Nov 12.

Reference Type BACKGROUND
PMID: 21074802 (View on PubMed)

Hollenbeck BK, Miller DC, Taub DA, Dunn RL, Khuri SF, Henderson WG, Montie JE, Underwood W 3rd, Wei JT. The effects of adjusting for case mix on mortality and length of stay following radical cystectomy. J Urol. 2006 Oct;176(4 Pt 1):1363-8. doi: 10.1016/j.juro.2006.06.015.

Reference Type BACKGROUND
PMID: 16952633 (View on PubMed)

Waitzberg DL, Saito H, Plank LD, Jamieson GG, Jagannath P, Hwang TL, Mijares JM, Bihari D. Postsurgical infections are reduced with specialized nutrition support. World J Surg. 2006 Aug;30(8):1592-604. doi: 10.1007/s00268-005-0657-x.

Reference Type BACKGROUND
PMID: 16794908 (View on PubMed)

Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery. 2002 Nov;132(5):805-14. doi: 10.1067/msy.2002.128350.

Reference Type BACKGROUND
PMID: 12464864 (View on PubMed)

Schiesser M, Kirchhoff P, Muller MK, Schafer M, Clavien PA. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery. 2009 May;145(5):519-26. doi: 10.1016/j.surg.2009.02.001. Epub 2009 Mar 27.

Reference Type BACKGROUND
PMID: 19375611 (View on PubMed)

Oh CA, Kim DH, Oh SJ, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy. World J Gastroenterol. 2012 Feb 21;18(7):673-8. doi: 10.3748/wjg.v18.i7.673.

Reference Type BACKGROUND
PMID: 22363139 (View on PubMed)

Giger U, Buchler M, Farhadi J, Berger D, Husler J, Schneider H, Krahenbuhl S, Krahenbuhl L. Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol. 2007 Oct;14(10):2798-806. doi: 10.1245/s10434-007-9407-7. Epub 2007 Jul 15.

Reference Type BACKGROUND
PMID: 17632760 (View on PubMed)

Other Identifiers

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PRO13060027

Identifier Type: -

Identifier Source: org_study_id