Fast-track- recovery surgery with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively among surgical gynaecological cancer patients: study protocol of an open-labelled, randomised controlled trial

Chiou Yi Ho, Zuriati Ibrahim, Zalina Abu Zaid, Zulfitri 'Azuan Mat Daud, Nor Baizura Md Yusop, Chiou Yi Ho, Zuriati Ibrahim, Zalina Abu Zaid, Zulfitri 'Azuan Mat Daud, Nor Baizura Md Yusop

Abstract

Introduction: There has been growing evidence on the favourable outcomes of fast-track-recovery (FTR) surgery; to expedite recovery, minimise complications, and reduce the length of hospital stay for surgical patients. However, there is lack of evidence on the effectiveness of FTR in surgical gynaecological cancer (GC) patients. Most of the previous studies did not focus on feeding composition in the FTR surgery protocol. This study aims to determine the effectiveness of FTR feeding with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively on post-operative outcomes among surgical GC patients.

Methods/design: This open-labelled, randomised controlled trial (RCT) will randomly allocate patients into intervention and control groups. Ambulated Malaysian aged over 18 years and scheduled for elective surgery for (suspected) GC, will be included in this study. The intervention group will be given whey-protein-infused carbohydrate-loading drinks on the evening before their operation and 3 h before their operation as well as started on early oral feeding 4 h post-operatively. The control group will be fasted overnight pre-operation and only allowed plain water, and return to a normal diet is allowed when bowel sounds return post-operatively. The primary outcomes of study are length of post-operative hospital stay, length of clear-fluid tolerance, solid-food tolerance and bowel function. Additional outcome measures are changes in nutritional status, biochemical profile and functional status. Data will be analysed on an intention-to-treat basis.

Trial registration: ClinicalTrials.gov, ID: NCT03667755. Retrospectively registered on 12 September 2018; Protocol version: version 3 dated 27 September 2017.

Keywords: Early oral feeding; Surgical gynaecological cancer; Whey-protein carbohydrate-loading.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. BJS. 1999;86(2):227–230. doi: 10.1046/j.1365-2168.1999.01023.x.
    1. Henriksen MG, Hessov I, Dela F, et al. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand. 2003;47(2):191–199. doi: 10.1034/j.1399-6576.2003.00047.x.
    1. Pexe-Machado PA, de Oliveira BD, Dock-Nascimento DB, et al. Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer. Nutrition. 2013;29(7):1054–1059. doi: 10.1016/j.nut.2013.02.003.
    1. Singh M, Chaudhary M, Vashistha A, et al. Evaluation of effects of a preoperative 2-hour fast with glutamine and carbohydrate rich drink on insulin resistance in maxillofacial surgery. J Oral Biol Craniofac Res. 2015;5(1):34–39. doi: 10.1016/j.jobcr.2015.02.006.
    1. Perrone F, da Silva-Filho AC, Adôrno IF, et al. Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial. Nutr J. 2011;10(1):66. doi: 10.1186/1475-2891-10-66.
    1. Dock-Nascimento DB, de Aguilar-Nascimento JE, Magalhaes Faria MS, et al. Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy. J Parenter Enter Nutr. 2012;36(1):43–52. doi: 10.1177/0148607111422719.
    1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–641. doi: 10.1016/S0002-9610(02)00866-8.
    1. Modesitt SC, Sarosiek BM, Trowbridge ER, et al. Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization. Obstet Gynecol. 2016;128(3):457–466. doi: 10.1097/aog.0000000000001555.
    1. Kalogera E, Bakkum-Gamez JN, Jankowski CJ, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122(2 Pt 1):319–328. doi: 10.1097/AOG.0b013e31829aa780.
    1. Knott A, Pathak S, McGrath JS, et al. Consensus views on implementation and measurement of enhanced recovery after surgery in England: Delphi study. BMJ Open. 2012;2(6):e001878. doi: 10.1136/bmjopen-2012-001878.
    1. Nelson G, Dowdy SC, Lasala J, et al. Enhanced recovery after surgery (ERAS®) in gynecologic oncology – practical considerations for program development. Gynecol Oncol. 2017;147(3):617–620. doi: 10.1016/j.ygyno.2017.09.023.
    1. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS(R)) Society Recommendations: 2018. World J Surg. 2019;43(3):659–695. doi: 10.1007/s00268-018-4844-y.
    1. Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth. 2015;62(2):99–104. doi: 10.1007/s12630-014-0261-3.
    1. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2013;37(2):259–284. doi: 10.1007/s00268-012-1772-0.
    1. Merg AR. MD Anderson Surgical oncology handbook, 3rd ed. Ann Surg. 2004;239(4):574. doi: 10.1097/01.sla.0000120068.58880.32.
    1. Conrad LB, Ramirez PT, Burke W, et al. Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the Society of Gynecologic Oncology. Int J Gynecol Cancer. 2015;25(6):1121–1127. doi: 10.1097/IGC.0000000000000450.
    1. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48. doi: 10.1016/j.clnu.2016.07.015.
    1. Kimball SR, Farrell PA, Jefferson LS. Invited review: role of insulin in translational control of protein synthesis in skeletal muscle by amino acids or exercise. J Appl Physiol. 2002;93(3):1168–1180. doi: 10.1152/japplphysiol.00221.2002.
    1. Lee TD, Gimenez G, Grishina G, et al. Profile of a milk-allergic patient who tolerated partially hydrolyzed whey formula. J Allergy Clin Immunol Pract. 2015;3(1):116–118. doi: 10.1016/j.jaip.2014.06.021.
    1. Balayla J, Bujold E, Lapensée L, et al. Early versus delayed postoperative feeding after major gynaecological surgery and its effects on clinical outcomes, patient satisfaction, and length of stay: a randomized controlled trial. J Obstet Gynaecol Can. 2015;37(12):1079–1085. doi: 10.1016/S1701-2163(16)30073-1.
    1. Baker J, Janda M, Graves N, et al. Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: results from a randomised trial. Gynecol Oncol. 2015;137(3):516–522. doi: 10.1016/j.ygyno.2015.03.048.
    1. Obermair A, Simunovic M, Isenring L, et al. Nutrition interventions in patients with gynecological cancers requiring surgery. Gynecol Oncol. 2017;145(1):192–199. doi: 10.1016/j.ygyno.2017.01.028.
    1. Holeček M. Branched-chain amino acids in health and disease: metabolism, alterations in blood plasma, and as supplements. Nutr Metab. 2018;15(1):33. doi: 10.1186/s12986-018-0271-1.
    1. Turner L, Shamseer L, Altman DG, et al. Consolidated Standards of Reporting Trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database Syst Rev. 2012;11:MR000030. doi: 10.1002/14651858.MR000030.pub2.
    1. Woodward M. Formulae for sample size, power and minimum detectable relative risk in medical studies. Journal of the Royal Statistical Society Series D. 1992;41(2):185–196. doi: 10.2307/2348252.
    1. Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–112. doi: 10.4103/2229-3485.83221.
    1. Arifin WN, Sarimah A, Norsa’adah B, et al. Reporting statistical results in medical journals. Malays J Med Sci. 2016;23(5):1–7. doi: 10.21315/mjms2016.23.5.1.
    1. Chan A-W, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Ariffin AC, Ahmad AW, Zuhdi Z, et al. Enhanced recovery after surgery (ERAS) post liver resection: safety and feasibility study. HPB. 2016;18:e539. doi: 10.1016/j.hpb.2016.03.438.
    1. Makuuchi R, Sugisawa N, Kaji S, et al. Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading. Eur J Surg Oncol. 2017;43(1):210–217. doi: 10.1016/j.ejso.2016.07.140.
    1. Maltby JR. Fasting from midnight – the history behind the dogma. Best Pract Res Clin Anaesthesiol. 2006;20(3):363–378. doi: 10.1016/j.bpa.2006.02.001.
    1. Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol. 2006;20(3):429–438. doi: 10.1016/j.bpa.2006.02.004.
    1. Gillis C, Carli F. Promoting perioperative metabolic and nutritional care. Anesthesiol: J Am Soc Anesthesiol. 2015;123(6):1455–1472. doi: 10.1097/aln.0000000000000795.
    1. Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag. 2008;4(5):913–917. doi: 10.2147/tcrm.s2390.
    1. Lassen K, Dejong CHC, Ljungqvist O, et al. Nutritional support and oral intake after gastric resection in five northern European countries. Dig Surg. 2005;22(5):346–352. doi: 10.1159/000089770.
    1. Nathan BN, Pain JA. Nasogastric suction after elective abdominal surgery: a randomised study. Ann R Coll Surg Engl. 1991;73(5):291–294.
    1. Bufo AJ, Feldman S, Daniels GA, et al. Early postoperative feeding. Dis Colon Rectum. 1994;37(12):1260–1265. doi: 10.1007/bf02257793.
    1. Verma R, Nelson RL. Prophylactic nasogastric decompression after abdominal surgery (Review). Cochrane Database Syst Rev. 2010;3(3). 10.1002/14651858.CD004929.pub3. Copyright.
    1. Dag A, Colak T, Turkmenoglu O, et al. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics. 2011;66:2001–2005. doi: 10.1590/S1807-59322011001200001.
    1. Chase DM, Lopez S, Nguyen C, et al. A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology? Am J Obstet Gynecol. 2008;199(5):541.e1–541.e7. doi: 10.1016/j.ajog.2008.04.037.

Source: PubMed

3
구독하다