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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05726786
Other study ID # INCyst
Secondary ID
Status Recruiting
Phase Phase 3
First received
Last updated
Start date April 10, 2023
Est. completion date October 2026

Study information

Verified date September 2023
Source Centre Hospitalier Universitaire Vaudois
Contact Ilaria Lucca, MD
Phone +41213142981
Email ilaria.lucca@chuv.ch
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The goal of this clinical trial research study is to evaluate the impact of preoperative oral immunonutrition (IN) on post-operative complications in patients undergoing a cystectomy. As a secondary focus, this study will aim to develop a signature that would identify patients that would benefit the most from IN. This is a multicentric (Swiss: N=3), prospective, controlled, pragmatic, parallel-group comparative study with block randomization stratified by centers.


Description:

Despite standardized surgical technique and the development of new perioperative care protocols, cystectomy morbidity remains a serious challenge for urologists. Most common postoperative complications, such as infections, often lead to longer length of stay and worse survival. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN), containing arginine, ribonucleic acid and omega-3 polyunsaturated fatty acids, aims to improve the nutritional status, immunological function and clinical outcome of surgical patients. Meta-analyses have demonstrated that preoperative IN reduces complications and length of hospital stay after major bowel surgery. Evidence-based data on preoperative oral IN support for cystectomy patients are lacking, which does not allow this treatment to be widely accepted, recommended, or reimbursed by health insurances in most European countries. Uncertainties also remain about the exact mechanism by which IN modulates the host immune response. Complication rates after cystectomy range from 40-75%. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. To date, and in the last 20 years, no single intervention has allowed for a significant reduction in morbidity after cystectomy, which remains one of the highest in surgery. The present adequately powered multicenter RCT has the potential of changing current practice by recommending preoperative IN before cystectomy in case of positive results. If the present RCT demonstrates a benefit in administrating IN prior to cystectomy, urological guidelines will be modified accordingly to this new evidence. IN will then be recommended before cystectomy for the patient's benefit. The investigators truly believe that the proposed study is of high clinical importance with potential impact on perioperative urology guidelines.


Recruitment information / eligibility

Status Recruiting
Enrollment 232
Est. completion date October 2026
Est. primary completion date August 2026
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Patient undergoing open cystectomy (for all reasons) - Age =18 years - Ability and willingness to provide informed consent documented by signature Exclusion Criteria: - Contraindications to IN, e.g. known hypersensitivity or allergy to lactose, fish oil or soy lecithin - Severe diarrhoea requiring medical attention - Current treatment with any immunosuppressive drug - In standard practice, pregnant or lactating women are systematically rejected by the surgeon for this surgical procedure. Furthermore, during the pre-surgical anaesthesia consultation, the eligibility of each patient for anaesthesia will be assessed according to the usual criteria and recommendations of the anaesthesia service of the CHUV - Other clinically significant concomitant disease affecting immunity (e.g., severe renal failure, HIV, SLE, transplant recipient, ...) - Inability to follow the procedures of the study, e.g. due psychological disorders, dementia, etc. - Participation in another study with investigational drug within the 30 days preceding and during the present study - Previous enrolment into the current study - Use of IN independently of the study - Enrolment of the investigator, his/her family members, employees and other dependent persons - Emergency procedure (less than 7 days between screening and surgery)

Study Design


Intervention

Drug:
Immunonutrition
Immunonutrition: Oral Impact®, Nestle´ Health Science, Switzerland. IN will be administered as per manufacturer suggestion, i.e. three times a day during 7 days preoperatively. Oral Impact® is a powdered oral feed that provides 309 kcal/bag

Locations

Country Name City State
Switzerland University Hospital of Bern Bern
Switzerland Centre Hospitalier Universitaire Vaudois, CHUV Lausanne VD
Switzerland Hospital of Riviera-Chablais Rennaz

Sponsors (3)

Lead Sponsor Collaborator
Centre Hospitalier Universitaire Vaudois Hôpital Riviera-Chablais, Vaud-Valais, Insel Gruppe AG, University Hospital Bern

Country where clinical trial is conducted

Switzerland, 

Outcome

Type Measure Description Time frame Safety issue
Other Cancer-specific survival rate Long term overall and cancer-specific survival for bladder cancer patients Postoperative time
Other Quality of life assessment Assessment of the quality of life after surgery through a questionnaire (EORTC QLQ-C30) 30 and 90 days after surgery
Other Identification of biomarkers predictive of postoperative complications Identification of biomarkers predictive of postoperative complications studying the patient's immune and microbiome signature: analysis of immune cells in the blood, analysis of the polyfunctionality of blood T cells, analysis of immune-related proteins in the urine and serum, microbiota analysis, expression of Argininosuccinate synthetase 1 Before and after immunonutrition treatement
Primary Infectious complication after cystectomy Determination of infectious complications rate at 30 days after surgery (pneumonia, urinary tract infection, surgical site infection, sepsis, shock). 30-days afetr surgery
Secondary Comprehensive Complication Index (CCI) Determination of the Comprehensive Complication Index (CCI) at 30 and 90 days after surgery. The range is between 0 (no complication) to 100 (death). 30 and 90 days after surgery
Secondary Mortality rate Determination of the mortality rate at 30 and 90 days after surgery 30 and 90 days after surgery
Secondary Complication-free survival rate Determination of the post-operative complication-free survival 90-days after surgery
Secondary Treatment compliance rate Serum arginine levels will be assessed at enrolment (between Day -30 and Day -10) and at preoperative admission after intake of the allocated nutrition (Day -1) in all patients treated at Lausanne, CHUV. Between Day -30 and Day -10 and at preoperative admission after intake of the allocated nutrition (Day -1)
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