A Single Centre Randomised Control Study to Assess the Impact of Pre-Operative Carbohydrate Loading on Women Undergoing Major Surgery for Epithelial Ovarian Cancer.

Deniz Al-Hirmizy,David Nugent,Ann Henry,Sean Duffy,Robert West,Nicholas Wood,Stanley Ko

doi:10.7759/cureus.10169

Abstract

ObjectiveHistorically, patients have fasted before elective surgery to ensure an empty stomach to avoid aspiration. A fasting-induced catabolic state however may adversely influence recovery after surgery. Our study was designed to test the effect of oral carbohydrate loading on clinical parameters in patients undergoing major surgery for advanced-stage ovarian cancer.MethodsA double-blinded single-centre randomised trial was designed to recruit 110 patients with advanced-stage epithelial ovarian cancer undergoing either primary surgery, or neoadjuvant chemotherapy prior to debulking surgery. Following written informed consent, the patients were randomised into two groups. Group 1 received the carbohydrate drink (intervention) and group 2 received flavoured water (placebo). The quantity of fluid in both groups was 800ml the night before the surgery and 400ml two hours before the induction of anaesthesia. The primary endpoint of the study was the Length of Hospital Stay (LoHS); the secondary parameters assessed were pain scores, nausea and vomiting scores, bowel function, and postoperative complication rate.ResultsBetween March 2009 and December 2011, 80 patients were randomised and 75 completed the study. A decision was made to close the trial early as a change in routine clinical practice meant that patients were admitted on the day of surgery rather than a day before. Analysis of the data revealed that there were no significant differences between the study groups in terms of LoHS and other clinical parameters.ConclusionIn this single-center study, which failed to recruit the planned number of patients, we were unable to demonstrate that oral carbohydrate intake pre-operatively has significant impact on the recovery process or the length of hospitalisation postoperatively. Future studies should examine all aspects of an Enhanced Recovery Program after Surgery as a package as compared to a single element to enhance patient outcome.

Highlights

Ovarian cancer is the second commonest gynaecological malignancy after endometrial cancer and the fifth most common female malignancy, with an approximate life time risk of one in 60 [1]
In this single-centre study, which failed to recruit the planned number of patients, we were unable to demonstrate that oral carbohydrate intake pre-operatively has significant impact on the recovery process or the length of hospitalisation postoperatively in patients undergoing pelvic surgery for ovarian cancer compared with oral hydration alone
The results show that there is little evidence to support that oral CHO loading pre-operatively may reduce the length of hospital stay

Summary

Introduction

Ovarian cancer is the second commonest gynaecological malignancy after endometrial cancer and the fifth most common female malignancy, with an approximate life time risk of one in 60 [1]. It is the most frequent cause of death among women who develop gynaecological cancer and the incidence is rising [2]. The majority of women present with advanced-stage disease and the five-year survival is relatively low at around 40% [3]. In the UK, 7000 new cases of epithelial ovarian cancer are diagnosed every year, with 4200 women dying from the disease annually [4]

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