Trial reportSurgical endoscopy2026
Restoring circadian homeostasis is associated with immune-metabolic recovery and medium-term oncologic outcomes after rectal cancer surgery: a prospective randomized trial.
Trial report in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMajor surgery disrupts circadian homeostasis, amplifying inflammatory and metabolic stress. The clinical implications of restoring temporal alignment on perioperative immune-metabolic recovery and medium-term oncologic outcomes remain incompletely defined.
methodsA two-stage prospective study was conducted at the First Affiliated Hospital of Soochow University (2019-2021). Study A (n = 300) characterized perioperative circadian disruption using a multimodal Circadian Rhythm Index (CRI). Study B (n = 240) was a randomized trial comparing standard ERAS with an integrated circadian reinforcement protocol including timed feeding, controlled light exposure, and low-dose melatonin. Co-primary endpoints were serum interleukin-6 (IL-6) AUC₀-₇d and percent change in the Prognostic Inflammatory and Nutritional Index (ΔPINI).
resultsSurgery markedly reduced CRI (83.5 ± 8.9 → 59.2 ± 11.8, p < 0.001). Lower baseline CRI predicted higher IL-6 peaks and increased complication risk. Circadian reinforcement reduced IL-6 AUC₀-₇d (362 ± 145 vs 518 ± 183 pg·day/mL; p < 0.001) and attenuated inflammatory-nutritional deterioration (ΔPINI -16.9 ± 10.3% vs -30.8 ± 11.4%; p < 0.001). Hospital stay was shorter (9 [8-11] vs. 11 [9-13] days; p = 0.002), and the intervention was associated with improved 3-year disease-free survival (HR 0.56 [0.35-0.89]; p = 0.014). Mediation analysis suggested that CRI improvement accounted for 27.8% of IL-6 reduction and 22.4% of ΔPINI benefit. No serious adverse events occurred.
conclusionsPerioperative circadian disruption represents a measurable and modifiable component of surgical stress. Behavioral and environmental circadian reinforcement was associated with improved immune-metabolic recovery and favorable clinical trajectories. Integration of circadian-based strategies within ERAS warrants further multicenter validation.
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