Influence of Esophageal Washout on Local Carcinoma Recurrence After Curative Resection

Not Applicable

Completed

• Conditions: Esophageal Neoplasms
• Interventions: Drug: Povidone-Iodine

• Registration Number: NCT02676791
• Lead Sponsor: Technische Universität Dresden

Brief Summary

The LOCARE-Trial is an investigator initiated, randomized-controlled trial with two parallel arms (n=60 each) and investigates the influence of esophageal washout on long-term outcomes in patients undergoing elective esophageal resection for carcinoma. The primary endpoint is defined as local carcinoma recurrence. Secondary endpoints will be locoregional and distant recurrence, disease-specific survival and esophageal cancer specific survival.

Detailed Description

Treatment of squamous cell carcinoma and adenocarcinoma of the esophagus has changed rapidly over the last decades due to implementation of multimodal cancer therapies such as radiotherapy or combined radiochemotherapy. Surgery, however, still is the mainstay of curative treatment options for this cancer entity. Due to the significant improvement in surgical technique and perioperative management, the postoperative mortality rate has fallen to about 5% with an estimated 5-year survival of 35%. Nevertheless, patients after esophagectomy are at high risk for local recurrence especially within the first 2 years after treatment. Independent risk factors for the development of carcinoma recurrence are incomplete resection (R1), extracapsular lymph node involvement and postoperative complications. Exfoliated, malignant cells remaining in luminal organs like the esophagus or colorectum could present another important risk factor for local recurrence especially at the site of anastomosis. In the treatment of rectal cancer, data have shown, that intraoperative rectal washout significantly reduces the risk of local recurrence from about 10% to 5%. For this reason, rectal washout during anterior resection has become a standard in many surgical institutions. Besides agents like cetrimide, sodium hypochlorite, formalin or saline, povidone-iodine has also been used for rectal mucosal application in prospective studies. Questions arise, weather similar positive outcomes could be achieved in esophageal surgery. The investigators hypothesize that esophageal washout with a povidone-iodine solution (Betaisodona®, Mundipharma) reduces the risk of local carcinoma recurrence after radical resection.

Study Timeline

• Study First Submitted: 2016-02-04
• Study First Submitted QC: 2016-02-05
• Study First Posted: 2016-02-08
• Study Start: 2016-02-16
• Primary Completion: 2021-09-24
• Study Completion: 2021-09-24
• Status Verified: 2022-07
• Last Update Submitted: 2022-07-13
• Last Update Posted: 2022-07-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• Patients scheduled for elective esophageal resection or esophagectomy
• Age equal or greater than 18 years
• Written informed consent
• Squamous cell carcinoma of the esophagus (SCC)
• Adenocarcinoma of the gastroesophageal junction (AEG) Type I

Exclusion Criteria

• Local irresectability or metastatic disease
• Adenocarcinoma of the gastroesophageal junction Type II and III
• Histopathological R1-resection
• Surgery for recurrence
• Iodine allergy
• Hyperthyreosis

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
A (Povidone-Iodine)	Povidone-Iodine	Esophageal washout will be performed via a nasogastric tube with approx. 50ml of a 11% povidone-iodine solution (Betaisodona®, Mundipharma) during esophageal resection.

Primary Outcome Measures

Name	Time	Method
Local carcinoma recurrence	36 months	Defined as development of a local recurrence after surgical treatment for esophageal cancer. The tumor is of identical histopathological type and occurs either on remained parts of the esophagus, at the site of anastomosis, on parts of an interposed organ (i.e. jejunum or colon) or in the original esophageal bed.

Trial Locations

Locations (1)

Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden; 🇩🇪 Dresden, Germany