Preemptive Endoluminal Negative Pressure Therapy at the Anastomotic Site in Minimally Invasive Transthoracic Esophagectomy - An International Multicenter Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Esophageal Cancer
- Sponsor
- University of Zurich
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Length of hospital stay until "fit-for-discharge" criteria are reached
- Last Updated
- 6 years ago
Overview
Brief Summary
The primary objective of the preSponge randomized controlled trial (RCT) will be to assess the potential protective effects of preemptive endoscopic negative pressure therapy (ENP) on postoperative morbidity in high-risk patients undergoing total minimally invasive transthoracic esophagectomy with gastric pull-up reconstruction and high intrathoracic anastomosis (thoracoscopic and laparoscopic Ivor Lewis esophagectomy).
Investigators
Christian Gutschow
Professor, Head of upper gastrointestinal unit
University of Zurich
Eligibility Criteria
Inclusion Criteria
- •We will include adult patients (≥18 years of age) with resectable esophageal cancer (adenocarcinoma or squamous cell carcinoma) with high risk for anastomotic leakage (AL) who provided informed consent and are scheduled for minimally invasive transthoracic Ivor Lewis esophagectomy. Robotic-assisted procedures will also be included.
- •Patients considered at high risk for AL must have at least one of the following risk factors:
- •American Society of Anesthesiologists Classification (ASA) score \>2
- •Diabetes (insulin dependent or HbA1c ≥ 6.5%)
- •Chronic pulmonary disease (first second of forced expiration (FEV1)/Forced volume vital capacity (FVC) ratio ≤ 70%)
- •Heart failure (left ventricular ejection fraction (LVEF) \<55%)
- •Preexisting cardiac arrhythmia (pacemaker or paroxysmal supraventricular tachyarrhythmia)
- •Chronic kidney disease stage 4-5 (glomerular filtration rate (GFR) \< 30ml/min/1.73 m2)
- •Chronic liver disease with treated portal hypertension (porto-caval pressure gradient ≥5-≤10mmHg, including patients with transjugular intrahepatic portosystemic shunt (TIPS))
- •Previous radiotherapy or chemo-radiation ≥50Gray (Gy) (salvage esophagectomy)
Exclusion Criteria
- •Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, or dementia.
- •Patients younger than 18 years
- •Patients undergoing esophagectomy for benign disease or for malignancy other than adenocarcinoma or squamous cell carcinoma
- •Patients scheduled for other technical variants of esophagectomy, such as open, hybrid, or transhiatal procedures (intraoperative conversions to open access surgery will not be excluded)
- •Chronic liver disease with portal hypertension (porto-caval pressure gradient \>10mmHg)
- •Distant organ metastasis (cM+)
Outcomes
Primary Outcomes
Length of hospital stay until "fit-for-discharge" criteria are reached
Time Frame: 90-days postoperatively
* The patients' oral/enteral nutritional requirements are met by oral intake of at least liquids with optional supplementary nutrition via jejunal feeding tube. * The patient should have passed flatus. * The patient does not require oxygen during mobilisation (short walk or climbing stairs) or at rest. * Central venous catheters should be removed before discharge (unless present preoperatively). * Adequate analgesia at rest and during mobilisation (pain score \<4 on a scale from 0 to 10) is achieved using both oral opioid and non-opioid analgesics. * All vital signs should be normal unless abnormal preoperatively. * Inflammatory parameters (white cell count, C-reactive protein) should be trending down and close to normal. * There should be adequate support after discharge (assistance by family, ambulatory nursing, or rehabilitation facility).
Secondary Outcomes
- Postoperative Complications(90-days postoperatively)