{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:53:58Z","timestamp":1791413638694,"version":"4.3.3"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Excess weight increases morbidity risk after colorectal cancer surgery.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the feasibility of a preoperative weight loss intervention.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n CARE was an assessor-blinded randomized clinical trial performed between March 27, 2023, to August 13, 2024, with a 30-day postoperative follow-up in adults with a body mass index of 28 or greater who were awaiting curative elective colorectal cancer resection at 8 hospitals across England.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Dietetic support with a low-energy (800 kcal\/d, 76 g\/d of protein) total diet replacement program between decision to treat and surgery.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Progression criteria for a definitive trial included recruitment (\u226572 patients), engagement (\u226575% of dietetic telephone calls attended), adherence (\u226560% of intervention participants achieving \u22655% weight loss), and retention (\u226585%). Secondary outcomes included morbidity, symptoms, and changes in weight and fat-free mass. Outcomes were modeled during a 30-year time horizon using cohort simulation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 150 potentially eligible participants approached, 71 eligible randomized participants (mean [SD] age, 64 [8.7] years; 43 [61%] male; mean [SD] body mass index, 35.4 [5.4]) undergoing surgery (36 in the intervention group and 35 in the usual care group) were included in the analysis. Participants were accrued at a rate of 0.57 participants per site per month compared with the anticipated rate of 0.75. Participants attended 85% of their dietetic calls. The median (IQR) period from randomization to surgery was 33 (25-43) days, during which 22 (61%) of the intervention participants and 3 (9%) of the usual care participants lost 5% or more of their weight (odds ratio, 16.8; 95% CI, 4.3-65.3). Intervention participants lost a mean (SD) of 6.1 (3.0) kg before surgery, which was 4.3 kg (95% CI, 2.7 to 5.8 kg) more than the usual care participants. Between-group adjusted change in fat-free mass was 0.1 kg (95% CI, \u22123.9 to 4.0 kg). There was no evidence of a difference between the 2 group in the proportion of patients with any complications (14 [39%] vs 14 [40%]) or with Clavien-Dindo grade I, II, or III complications. Fecal incontinence (\u22128.6 points [95% CI, \u221216.7 to \u22120.5 points]) and sore skin (\u221215.9 points (95% CI, \u221225.3 to \u22126.6 points]) improved postoperatively in the intervention compared with usual care group. There were no intervention-related serious adverse events. Retention was 100%. In an exploratory observational analysis, participants who lost 3.2% or more of their body weight (above the median loss) had a 50% relative reduction in complications (95% CI, 1%-78%). Modeling indicated that the intervention was cost-effective.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial\u2019s intervention of low-energy total diet replacement before colorectal cancer resection was feasible and well tolerated, lacked safety concerns, and was likely cost-effective. The progression criteria were met, but some recruitment challenges need to be addressed.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ISRCTN.org Identifier:\n ISRCTN39207707<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.47126","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:00:32Z","timestamp":1765209632000},"page":"e2547126","source":"Crossref","is-referenced-by-count":10,"title":["Preoperative Weight Loss in Patients With Excess Weight and Colorectal Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Dimitrios A.","family":"Koutoukidis","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"NIHR Oxford Biomedical Research Centre, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Jebb","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"NIHR Oxford Biomedical Research Centre, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. 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