TOPLINE:
In patients with excess weight awaiting colorectal cancer (CRC) surgery, a low-energy total diet replacement (TDR) program was feasible, well tolerated, and associated with greater preoperative weight loss and improvements in some patient-reported symptoms than usual care.
METHODOLOGY:
- CRC surgery carries a higher risk for postoperative morbidity than many other major abdominal operations, and excess weight further increases the risk. This prospective, randomized clinical trial conducted at nine hospitals across England assessed the feasibility and safety of a TDR program before CRC resections.
- Eligible patients had a BMI of 28 or higher, were awaiting curative CRC resection, and had a World Health Organization performance status of 0-2.
- A total of 71 eligible patients (mean age, 64 years; 61% men; mean BMI, 35.4) were randomly assigned to either the intervention group or the usual care group.
- The intervention involved dietitian-supported TDR (~800 kcal/d, including 76 g/d of protein) from the decision to treat to surgery, a 45-minute introductory phone consult, weekly 20-minute follow-up calls, and a brief exit call, in addition to usual care.
- The primary outcomes were recruitment, engagement, adherence, retention, and safety, assessed during the 30-day postoperative follow-up period. Complications were assessed using the Clavien-Dindo scale and Comprehensive Complication Index.
TAKEAWAY:
- The intervention group lost 4.3 kg more weight than the usual care group before resection and maintained that between-group difference at 30 days post-surgery. No significant between-group difference was noted in fat-free mass.
- In the intervention group, participants attended a mean of 85% of dietetic calls; 97% started and 89% completed the intervention, and the retention rate was 100%. No serious intervention-related adverse events were reported.
- On a cancer quality-of-life questionnaire, scores for fecal incontinence and sore skin were 8.6 points lower and 15.9 points lower in the intervention group than in the usual care group among patients without a stoma. No significant between-group difference was found in the proportion of patients with any complication (about 40% in both groups) or with Clavien-Dindo grade I-III complications.
- In an exploratory observational analysis, patients who lost 3.2% or more of their body weight compared with those who lost less weight had a 50% relative reduction in complications. Modeling suggested the intervention was likely cost-effective.
IN PRACTICE:
“An intensive preoperative weight-loss intervention was safe, feasible, and likely cost-effective as part of prehabilitation before colorectal cancer surgery with evidence of improvements in key symptoms,” the authors of the study wrote.
SOURCE:
This study, led by Dimitrios A. Koutoukidis, PhD, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, was published online on December 8 in JAMA Network Open.
LIMITATIONS:
This study was underpowered to precisely detect differences in secondary and exploratory outcomes. Patients in the usual care group lost about 2 kg, and most reported conscious efforts to lose weight, which may reflect a halo effect of their participation in a weight-loss study rather than usual care. More frequent dietitian contact in the intervention arm may have increased adverse event reporting.
DISCLOSURES:
This study received funding from the University of Oxford and the UK National Institute for Health and Care Research (NIHR). Several authors reported receiving support from multiple organizations including NIHR, the Pharsalia Trust UK, and Cancer Research UK Advanced Clinical Scientist Fellowship. Two authors reported receiving nonfinancial support from Nestlé Health Science, Oviva, and Second Nature outside of the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.