Postoperative GI Dysfunction and Nutrition in Malnourished Cancer Surgery Patients (GIDNUT)
Gastrointestinal Dysfunction, Nutritional Status, and Delirium in the Early Postoperative Period in Oncologic Surgical Patients With Pre-existing Malnutrition: A Prospective Two-Center Observational Cohort Study
This is a prospective two-center observational cohort study in adult patients undergoing major abdominal and/or pelvic oncologic surgery with pre-existing malnutrition. The study describes the course of postoperative gastrointestinal dysfunction and evaluates whether real-world exposure to parenteral serotonin as part of routine postoperative care is associated with a higher proportion of patients whose gastrointestinal dysfunction regresses to LIFE score less than or equal to 1 by postoperative day 5 (plus or minus 1 day), compared with patients not exposed to serotonin.
All treatment decisions, including the use of parenteral serotonin, metoclopramide, neostigmine, nutritional support, and other postoperative management, are made solely by the treating physicians in accordance with routine clinical practice. The protocol does not assign, randomize, require, or restrict any drug treatment; it records real-world care, daily LIFE assessments during postoperative days 1 through 7, nutritional status measures, body composition where available, delirium screening, complications, length of stay, and mortality.
調査の概要
状態
詳細な説明
Disease-related malnutrition and sarcopenia are common in patients undergoing major abdominal or pelvic oncologic surgery and are associated with worse postoperative outcomes, including more complications, prolonged hospital stay, and increased mortality. Postoperative gastrointestinal dysfunction may further impair tolerance of enteral nutrition and delay recovery, especially in patients with baseline malnutrition.
In routine practice at the participating centers, postoperative gastrointestinal dysfunction or functional ileus may be managed with different pharmacologic approaches, including metoclopramide, neostigmine, and in some patients parenteral serotonin. The choice of therapy, dose, timing, and duration is determined entirely by the treating clinicians according to routine care, approved labeling, and local institutional practice; no treatment is assigned by the protocol.
This study prospectively enrolls approximately 120 adult patients with histologically or cytologically confirmed malignancy who are scheduled for major abdominal and/or pelvic oncologic surgery and have pre-existing malnutrition defined by NRS-2002 score at least 3 plus at least one phenotypic and one etiologic GLIM criterion. Participants are observed from the preoperative period through discharge or postoperative day 30, whichever occurs first.
Exposure cohorts are defined after inclusion according to whether parenteral serotonin was actually received during the early postoperative period as part of routine care. The primary endpoint is the proportion of participants with regression of gastrointestinal dysfunction to LIFE score less than or equal to 1 by postoperative day 5 within the postoperative day 4 to 6 assessment window.
Secondary outcomes include the trajectory of LIFE scores during postoperative days 1 to 7, time to restoration of gastrointestinal motility, time to achievement of at least 60 to 70 percent of calculated energy requirements via enteral nutrition, changes in nutritional status and body composition, delirium incidence and duration, postoperative complications graded by Clavien-Dindo, infectious complications, ICU and hospital length of stay, and mortality. The study is exploratory and is intended to characterize real-world postoperative trajectories and generate effect-size estimates for future studies rather than provide definitive proof of treatment superiority.
研究の種類
入学 (推定)
連絡先と場所
研究連絡先
- 名前：Igor Vrublevskii
- 電話番号：+79672769997
- メール：tender@ph-arma.ru
研究場所
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Saint Petersburg、ロシア、194291
- North-Western District Scientific and Clinical Center named after L.G. Sokolov, FMBA of Russia
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参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Age ≥ 18 years.
- Histologically confirmed malignant tumor of the abdomen or pelvis with planned radical or cytoreductive surgery.
- Baseline malnutrition defined as NRS2002 ≥ 3 and at least one phenotypic and one etiologic GLIM criterion.
- Expected postoperative hospitalization ≥ 7 days.
- Ability to undergo baseline cognitive and nutritional assessments (MoCA, NRS2002, GLIM, PG-SGA) prior to surgery.
- Signed informed consent for participation and data collection.
Exclusion Criteria:
- Severe decompensated hepatic or renal failure rendering surgery infeasible.
- Documented preexisting severe cognitive impairment or dementia precluding valid postoperative cognitive/delirium assessment (e.g., MoCA < 18 or documented dementia).
- Pregnancy or breastfeeding.
- Participation in another interventional randomized clinical trial within the prior 30 days that could confound outcomes.
- Inability to ensure postoperative follow-up or reliable data collection (planned transfer without access, loss of contact).
研究計画
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
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Serotonin Cohort
Participants who receive parenteral serotonin, such as serotonin adipinate, at any time during the early postoperative period as part of routine clinical management of postoperative gastrointestinal dysfunction or functional ileus, at the discretion of the treating physician.
Exposure is observed and recorded; it is not assigned by protocol.
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Parenteral serotonin administered postoperatively per treating physician's discretion.
Dose, duration, and co-administration with other prokinetics recorded.
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No Serotonin Cohort
Participants who do not receive parenteral serotonin during the index hospitalization.
Other standard prokinetic agents, including metoclopramide or neostigmine, may be used according to routine clinical care.
Exposure is observed and recorded; it is not assigned by protocol.
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Use of metoclopramide, neostigmine, or other prokinetics per local practice, without serotonin.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Proportion of participants with LIFE ≤ 1 by postoperative day 5 (POD5 ±1 day)
時間枠：Postoperative day (POD) 5 ± 1 day (assessment window POD4-POD6)
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The proportion of participants whose gastrointestinal dysfunction regresses to a Lausanne Intestinal Failure Estimation (LIFE) score of ≤1 within the assessment window (POD4-POD6).
LIFE is assessed once daily from POD1 through POD7 using routine clinical parameters.
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Postoperative day (POD) 5 ± 1 day (assessment window POD4-POD6)
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Mean LIFE score from postoperative day 1 through postoperative day 7
時間枠：Postoperative Days 1-7
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Average of daily LIFE scores measured once per day from POD1 to POD7.
LIFE is a composite clinical score of gastrointestinal dysfunction.
Mean LIFE over this period will be compared between serotonin exposed and non exposed cohorts to describe the trajectory of GI function.
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Postoperative Days 1-7
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Time to restoration of gastrointestinal motility (first spontaneous bowel movement without clinical signs of significant GID)
時間枠：From the date of surgery until the date of the first documented spontaneous bowel movement without clinically significant gastrointestinal dysfunction, assessed up to 30 days after surgery
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Number of days from surgery to the first documented spontaneous bowel movement without clinically significant ongoing gastrointestinal dysfunction (as judged by the treating team and LIFE score).
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From the date of surgery until the date of the first documented spontaneous bowel movement without clinically significant gastrointestinal dysfunction, assessed up to 30 days after surgery
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Number of participants with at least one episode of delirium
時間枠：From postoperative day 0 through postoperative day 10 after surgery or until hospital discharge, whichever occurs first.
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Proportion of participants with at least one positive delirium assessment using CAM ICU or ICDSC during ICU and ward stay.
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From postoperative day 0 through postoperative day 10 after surgery or until hospital discharge, whichever occurs first.
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Number of delirium days
時間枠：From postoperative day 0 through postoperative day 10 after surgery or until hospital discharge, whichever occurs first.
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Total number of calendar days with positive CAM-ICU or ICDSC assessments.
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From postoperative day 0 through postoperative day 10 after surgery or until hospital discharge, whichever occurs first.
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Frequency of surgical complications (Clavien-Dindo, grade II-V)
時間枠：Up to 30 days after surgery
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Proportion of participants who develop at least one postoperative complication of Clavien-Dindo grade II or higher; separate reporting of grade III-V complications.
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Up to 30 days after surgery
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Frequency of infectious complications
時間枠：Up to 30 days after surgery
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Proportion of participants with clinically diagnosed infectious complications (e.g., surgical site infection, pneumonia, intra abdominal abscess, sepsis) during the index hospitalization.
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Up to 30 days after surgery
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ICU length of stay (days) and hospital length of stay (days)
時間枠：Up to 30 days after surgery
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Number of days spent
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Up to 30 days after surgery
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In-hospital mortality and 30-day mortality
時間枠：Up to 30 days after surgery
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Proportion of participants who die
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Up to 30 days after surgery
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Safety outcomes (CTCAE v6.0)
時間枠：From the index hospitalization through 30 days after surgery
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Incidence of cardiovascular, hematologic, metabolic, and neuropsychiatric adverse events with emphasis on thrombotic events, serious arrhythmias, severe hypertensive reactions, and events compatible with serotonin syndrome
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From the index hospitalization through 30 days after surgery
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その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change in body weight
時間枠：From preoperative baseline to hospital discharge, assessed up to 30 days after surgery.
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Difference in body weight (kg) between baseline and discharge.
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From preoperative baseline to hospital discharge, assessed up to 30 days after surgery.
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Change in mid-upper arm circumference
時間枠：From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Difference in mid upper arm circumference (cm) as a simple anthropometric marker of muscle mass.
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From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Change in fat-free mass (FFM)
時間枠：Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Difference in FFM (kg) between baseline and postoperative day 6-10 (or discharge).
For participants in whom bioelectrical impedance analysis (BIA) is performed as part of extended clinical assessment.
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Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Change in skeletal muscle mass (SMM)
時間枠：Postoperative Day 6-10
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Difference in SMM (kg) between baseline and postoperative day 6-10 (or discharge).
For participants in whom bioelectrical impedance analysis (BIA) is performed as part of extended clinical assessment.
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Postoperative Day 6-10
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Change in skeletal muscle mass index (SMMI)
時間枠：Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Difference in SMMI (kg/m²) between baseline and postoperative day 6-10 (or discharge).
For participants in whom bioelectrical impedance analysis (BIA) is performed as part of extended clinical assessment.
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Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Change in phase angle
時間枠：Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Difference in phase angle (degrees) between baseline and postoperative day 6-10 (or discharge).For participants in whom bioelectrical impedance analysis (BIA) is performed as part of extended clinical assessment.
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Postoperative Day 6-10 or at hospital discharge, whichever occurs first
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Change in Nutritional Risk Screening 2002 (NRS-2002) score from baseline to discharge
時間枠：From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Difference in Nutritional Risk Screening 2002 (NRS-2002) total score between baseline (preoperative assessment) and the day of hospital discharge.
The NRS-2002 total score ranges from 0 to 7; higher scores indicate greater nutritional risk.
For reporting, present mean (SD) change and number (%) of participants with clinically relevant change (e.g., change ≥1 point).
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From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Change in Global Leadership Initiative on Malnutrition (GLIM) malnutrition severity category from baseline to discharge
時間枠：From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Change in malnutrition severity category as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria between the preoperative baseline assessment and the day of hospital discharge.
GLIM categories to be reported: No malnutrition, Moderate malnutrition, Severe malnutrition.
For results reporting, present the number and proportion of participants in each GLIM category at baseline and at discharge, and the number and proportion of participants with a change in category (e.g., Moderate → Severe, Severe → Moderate, Any worsening, Any improvement).
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From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Change in Patient-Generated Subjective Global Assessment (PG-SGA) total score from baseline to discharge
時間枠：From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Difference in Patient-Generated Subjective Global Assessment (PG-SGA) total score between baseline (preoperative assessment) and the day of hospital discharge.
PG-SGA is a validated nutritional assessment instrument; higher total scores indicate worse nutritional status.
For results reporting, present mean (SD) change and median (IQR), and report the number and proportion of participants with a clinically meaningful change (predefined in the SAP; e.g., change ≥2 points).
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From preoperative baseline assessment to the day of hospital discharge, assessed up to 30 days after surgery
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Time to achievement of enteral nutrition ≥60-70% of calculated energy requirement
時間枠：From initiation of postoperative nutritional support up to 30 days after surgery
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Number of days from initiation of postoperative nutritional support to the first day on which ≥60-70% of calculated daily energy requirements are delivered via the enteral route, sustained according to local practice.
Calculated energy targets follow institutional nutritional protocols (typically ~25-30 kcal/kg/day).
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From initiation of postoperative nutritional support up to 30 days after surgery
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協力者と研究者
スポンサー
研究記録日
主要日程の研究
研究開始 (推定)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- ARMA-GIDNUT-O-2026-01
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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