Postoperative Diet with an Oligomeric Hyperproteic Normocaloric Supplement versus a Supplement with Immunonutrients in Colorectal Cancer Surgery: Results of a Multicenter, Double-Blind, Randomized Clinical Trial

Abstract

(1) Background: For normo-nourished colorectal cancer patients, the need for immunonutrients after elective surgery is not known. (2) Methods: Multicenter, randomized, double-blind, phase III clinical trial comparing the postoperative diet with 200 mL oligomeric hyperproteic normocaloric (OHN; experimental arm) supplement vs. 200 mL immunonutritional (IN) (active comparator) supplement twice a day for five days in 151 normo-nourished adult colorectal-resection patients following the multimodal rehabilitation ERAS protocol. The proportions of patients with complications (primary outcome) and those who were readmitted, hospitalized for <7 days, had surgical site infections, or died due to surgical complications (secondary outcome) were compared between the two groups until postoperative day 30. Tolerance to both types of supplement and blood parameters was also assessed until day 5. (3) Results: Mean age was 69.2 and 84 (58.7%) were men. Complications were reported in 41 (28.7%) patients and the incidence did not differ between groups (18 (25%) vs. 23 (32.4%) patients with OHN and IN supplement, respectively; p = 0.328). No significant differences were found for the rest of the variables. (4) Conclusions: IN supplement may not be necessary for the postoperative recovery of colorectal cancer patients under the ERAS regimen and with normal nutritional status at the time of surgery.

The role of dietary prehabilitation on anastomotic healing

“…Although an emerging trend is to provide probiotic organisms to ‘repopulate’ the gut microbiome prior to surgery, such approaches are based on poorly designed observational studies that lack a compelling mechanistic basis to their function [36 ▪ ,37]. Other approaches suggest that ‘immunonutrition’ via a chemically defined, sterile, fiber-free liquid diet can ‘redirect’ the microbiome and immune system toward a recovery directed response to surgery [38,39]. Yet leveraging the power of one's own microbiome by providing it with its preferred substrate using a short-term plant based, high fiber low fat diet appears to be most supported by credible science.…”

“…These findings offer the opportunity to modulate the gut microbiome to facilitate rapid uneventful recovery in patients undergoing major anastomotic surgery. Although an emerging trend is to provide probiotic organisms to 'repopulate' the gut microbiome prior to surgery, such approaches are based on poorly designed observational studies that lack a compelling mechanistic basis to their function [36 can 'redirect' the microbiome and immune system toward a recovery directed response to surgery [38,39]. Yet leveraging the power of one's own microbiome by providing it with its preferred substrate using a short-term plant based, high fiber low fat diet appears to be most supported by credible science.…”