Perioperative Immunonutrition, Phagocytic and Bactericidal Activity of Blood Platelets in Gastric Cancer Patients

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by Medical University of Bialystok
Sponsor:
Information provided by (Responsible Party):
Medical University of Bialystok
ClinicalTrials.gov Identifier:
NCT01704664
First received: September 26, 2012
Last updated: May 29, 2015
Last verified: March 2014
  Purpose

Perioperative immunonutrition in gastric cancer patients can reduce perioperative morbidity and may improve quality of their life. Patients with gastric cancer will be divided into four groups depending on the type of artificial nutrition. Group I (enteral feeding) and II (enteral feeding and parenteral nutrition with glutamine) will be administered nutritional therapy during the postoperative period, group III (oral arginine) and IV (parenteral immunonurition) patients will be treated nutritionally both prior to and after the surgery. The lymphocytes and their subpopulations, interleukin IL-1B,-6,-23, and the phagocytic, and bactericidal activity of blood platelets will be determined before and after nutritional therapy.


Condition Intervention
Gastric Cancer
Dietary Supplement: Early postoperative enteral nutrition, based on standard elementary diet (Peptisorb)
Drug: glutamine
Dietary Supplement: oral diet enriched with arginine (Cubitan)
Drug: Perioperative parenteral immunonutrition (Dipeptiven, Omegaven)

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
Official Title: Prospective Study of the Effect of Perioperative Immunonutrition on the Immune Host Defense and the Phagocytic and Bactericidal Activity of Blood Platelets in Gastric Cancer Patients.

Resource links provided by NLM:


Further study details as provided by Medical University of Bialystok:

Primary Outcome Measures:
  • Phagocytic activity of blood platelets in gastric cancer patients. [ Time Frame: Participans will be followed for the duration of hospital stay, an expected average of 3 weeks ] [ Designated as safety issue: Yes ]
    Platelet count and phagocytic activity of thrombocytes will be examined twice in each patient. Blood samples for laboratory tests will be drawn prior to surgery and nutritional therapy and 12 days after the surgery. Thrombocyte count will be determined using Advia 120 haematological analyser. Phagocytic activity of blood platelets will be determined against Staphylococcus aureus ATCC 6538P bacterial strain. It expresses as the fraction of phagocytizing platelets and the phagocytic index. The fraction of phagocytizing platelets corresponds to the percentage of phagocyting thrombocytes per 1000 consecutive cells of this type. The phagocytic index represents the ratio of phagocytized bacteria per 100 phagocytic platelets.


Estimated Enrollment: 240
Study Start Date: March 2007
Estimated Study Completion Date: July 2017
Estimated Primary Completion Date: July 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: I - Nutritional therapy only during the postoperative period.
Postoperative nutritional therapy administered in group I will not include immunomodulating factors. Early postoperative enteral nutrition, based on standard elementary diet (Peptisorb), starts 20 hours post-surgery. The initial flow rate will be 8 ml/h, which will be increased gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition will be continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins (commercially available two-chamber bag for peripheral access with 480 kcal of energetic value and 5.7g of N contained in standard amino acids).
Dietary Supplement: Early postoperative enteral nutrition, based on standard elementary diet (Peptisorb)
Early postoperative enteral nutrition with standard elementary diet (Peptisorb), will start 20 hours post-surgery. The initial flow rate will be 8 ml/h, which will increase gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition wil be continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins (commercially available two-chamber bag for peripheral access with 480 kcal of energetic value and 5.7g of N contained in standard amino acids).
Active Comparator: II - parenteral gltuamine in postoperative time
The nutritional therapy of group II patients will start post-surgery. It will be based on early enteral nutrition with elementary diet (Peptisorb) with simultaneous parenteral nutrition with two-chamber bag with 480 kcal energetic value and 5.7g of N contained in standard amino acids administered via peripheral veins. Additionally, glutamine (100 ml of Dipeptiven) will be added to the two-chamber bag. The parenteral nutrition will be administered for five days.
Dietary Supplement: Early postoperative enteral nutrition, based on standard elementary diet (Peptisorb)
Early postoperative enteral nutrition with standard elementary diet (Peptisorb), will start 20 hours post-surgery. The initial flow rate will be 8 ml/h, which will increase gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition wil be continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins (commercially available two-chamber bag for peripheral access with 480 kcal of energetic value and 5.7g of N contained in standard amino acids).
Drug: glutamine
The nutritional therapy of group II patients will start post-surgery. It will be based on early enteral nutrition with elementary diet (Peptisorb) with simultaneous parenteral nutrition with two-chamber bag with 480 kcal energetic value and 5.7g of N contained in standard amino acids administered via peripheral veins. Additionally, glutamine (100 ml of Dipeptiven) will be added to the two-chamber bag. The parenteral nutrition will be administered for five days.
Active Comparator: III - perioperative oral immunonutrition
Preoperatively, group III patients will be given commercially available oral diet enriched with arginine (Cubitan, 1 package 3 times per day). Additionally, they will be administered commercially available two-chamber bag with 480 kcal energetic value and 5.7g of N in standard amino acids via peripheral access. The duration of pre-operative preparatory phase ranged between 5 and 10 days (8 days on average). Enteral nutrition with commercially available arginine-containing diet (Cubison) will start 20 hours post-surgery at an 8 ml/h flow rate; the rate will be increased gradually, with the volume doubled every 24 hours, up to 100 ml/h and continued for six days. Simultaneously, commercially available two-chamber bags for peripheral access with composition identical to that used preoperatively will be administered via peripheral veins for five days.
Dietary Supplement: oral diet enriched with arginine (Cubitan)
Preoperatively, group III patients will be given commercially available oral diet enriched with arginine (Cubitan, 1 package 3 times per day). Additionally, they were administered commercially available two-chamber bag with 480 kcal energetic value and 5.7g of N in standard amino acids via peripheral access. The duration of pre-operative preparatory phase ranged between 5 and 10 days (8 days on average). Enteral nutrition with commercially available arginine-containing diet (Cubison) will start 20 hours post-surgery at an 8 ml/h flow rate; the rate will increase gradually, with the volume doubled every 24 hours, up to 100 ml/h and continued for six days. Simultaneously, commercially available two-chamber bags for peripheral access with composition identical to that used preoperatively will be administered via peripheral veins for five days.
Active Comparator: IV - Perioperative parenteral immunonutrition
Nutritional therapy of group IV will be based on intravenous preparations. Two-chamber bags with 480 kcal energetic value and 5.7 g of N in standard amino acids will be administered preoperatively. A solution of glutamine (Dipeptiven, 100 ml) and ω3-fatty acids (Omegaven, 100 ml) will be added to the bags. The duration of pre-operative preparatory phase ranged between 5 and 10 days (8 days on average). Enteral nutrition with elementary commercially available diet (Peptisorb) will be begun 20 hours post-surgery; it will be started at an 8 ml/h flow rate and increased gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition will be continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins; similarly to the preoperative period, the content of two-chamber bag for peripheral access enriched with glutamine and ω3-fatty acids will be administered for five days.
Dietary Supplement: Early postoperative enteral nutrition, based on standard elementary diet (Peptisorb)
Early postoperative enteral nutrition with standard elementary diet (Peptisorb), will start 20 hours post-surgery. The initial flow rate will be 8 ml/h, which will increase gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition wil be continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins (commercially available two-chamber bag for peripheral access with 480 kcal of energetic value and 5.7g of N contained in standard amino acids).
Drug: Perioperative parenteral immunonutrition (Dipeptiven, Omegaven)
Nutritional therapy of group IV will based on intravenous preparations. Two-chamber bags with 480 kcal energetic value and 5.7 g of N in standard amino acids were administered preoperatively. A solution of glutamine (Dipeptiven, 100 ml) and ω3-fatty acids (Omegaven, 100 ml) will be added to the bags. The duration of pre-operative preparatory phase ranged between 5 and 10 days (8 days on average). Enteral nutrition with elementary commercially available diet (Peptisorb) will be begun 20 hours post-surgery; it will start at an 8 ml/h flow rate and increased gradually, with the volume doubled every 24 hours, up to 100 ml/h. The enteral nutrition was continued for six days. During the initial five days post-surgery, the patients will be additionally supplemented parenterally via peripheral veins; similarly to the preoperative period, the content of two-chamber bag for peripheral access enriched with glutamine and ω3-fatty acids will be administered for five days.

Detailed Description:

Surgical treatment of gastric cancer is associated with a high risk of perioperative complications. Morbidity of cancer patients increases in concert with the clinical stage of the malignancy. It is postulated that a reduction in perioperative morbidity and improved quality of life of patients with advanced gastric cancer can be achieved by proper preparation to surgery, among others. One of such methods is the implementation of immunostimulating nutritional therapy during the perioperative period.The stage of cancer will be graded according to TNM classification. The patients will be randomly assigned to four clinical groups based on the type of nutritional therapy implemented.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • gastric cancer

Exclusion Criteria:

  • for group III constituted gastric cancer associated with severe gastrointestinal obstruction
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01704664

Contacts
Contact: Zbigniew Kamocki, MD PhD +48606452246 zkamocki@yahoo.com

Locations
Poland
Medical University of Bialystok Recruiting
Bialystok, Podlaskie, Poland, 15089
Contact: Zbigniew Kamocki, MD PhD    +48606452246    zkamocki@yahoo.com   
Principal Investigator: Zbigniew Kamocki, MD PhD         
Sub-Investigator: Joanna Matowicka-Karna, MD PhD         
Sub-Investigator: Joanna Osada, MD PhD         
Sponsors and Collaborators
Medical University of Bialystok
Investigators
Principal Investigator: Zbigniew Kamocki, MD PhD 2nd Department of General and Gastroenterological Surgery Medical University of Bialystok
  More Information

Publications:
Noisakran S, Gibbons RV, Songprakhon P, Jairungsri A, Ajariyakhajorn Ch, Nisalak A, Jarman RG, Malasit P, Chokephaibulkit K, Perng GC. Detection of dengue virus in platelets isolated from dengue patients. Southeast Asian J Trop Med Public Health. 2009; 40: 253-262. Mustard JF, Packham MA. Platelet phagocytosis. Sem Haematol 1968; 2: 168-184. Clawson CC, White JG.: Platelet interaction with bacteria. I Reaction phases and effects on inhibitors. Am I Pathol 1971; 65: 367-380. Kemona H, Andrzejewska A, Prokopowicz J, Nowak H, Mantur M. Phagocytic activity of human blood platelets examined by electron microscopy. Folia Haematol Int Mag Klin Morphol Blutforsch 1986; 113: 696-702. Bessler H, Agam G, Diadetti M. Increased protein synthesis by human platelets during phagocytosis of latex particles in vivo. Thromb Diath Haemorrh 1976; 35: 350-357. Tang YQ, Yeaman MR, Selsted ME. Antimicrobial peptides from human platelets. Infect Immun 2002; 70: 6524-6533. Yeaman MR. The role of platelets in antimicrobial host defense. Clin Infect Dis 1997; 5: 951-968. Page CP. Platelets as inflammatory cells. Immunopharmacology 1989; 17: 51-59. Sun B, Li J, Kambayashi J. Interaction between GPIbalpha and FcgammaIIa receptor in human platelets. Biochem Biophys Res Commun 1999; 266: 24-27. Kemona H, Andrzejewska A, Prokopowicz J, Nowak H, Mantur M. Phagocytic activity of human blood platelets examined by electron microscopy. Folia Haematol 1986; 113: 696-702. Nash GF, Turner LF, Scully MF, Kakkar AK. Platelets and cancer. Lancet Oncol 2002; 3: 425-430. Yu Y, Zhou XD, Liu YK, Ren N, Chen J. Platelets promote the adhesion of human hepatoma cells with highly metastatic potential to extracellular matrix protein: involvement of platelets P-selectin and GP IIb-IIIa. J Cancer Res Clin Oncol 2002; 128: 283-287. Kamocki Z, Matowicka-Karna J, Piotrowski Z, Kemona H. Bacteriocidal capacity of platelets in gastric cancer patients. Neoplasma 2004; 51: 265-268

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Medical University of Bialystok
ClinicalTrials.gov Identifier: NCT01704664     History of Changes
Other Study ID Numbers: 3-37878 L
Study First Received: September 26, 2012
Last Updated: May 29, 2015
Health Authority: Poland: Ministry of Science and Higher Education

Keywords provided by Medical University of Bialystok:
malnutrition,
perioperative artificial nutrition,
immunonutrition,
gastrectomy,
lymphocytes,
interleukin,
blood platelets,
phagocytic and bactericidal activity of blood platelets

Additional relevant MeSH terms:
Stomach Neoplasms
Digestive System Diseases
Digestive System Neoplasms
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Neoplasms
Neoplasms by Site
Stomach Diseases

ClinicalTrials.gov processed this record on August 30, 2015