eXtended Antibiotic Prophylaxis for Intermediate- and High-risk Glands After Pancreatoduodenectomy to Reduce CR-POPF
- Conditions
- Pancreatic Fistula
- Interventions
- Drug: Piperacillin/TazobactamDrug: Amoxicillin/ Clavulanic acid
- Registration Number
- NCT05753735
- Lead Sponsor
- Case Comprehensive Cancer Center
- Brief Summary
The purpose of this clinical trial is to investigate if prolonged antibiotics after pancreatoduodenectomy can prevent the development of a pancreatic fistula and related complications. Participants who are at high risk of pancreatic fistula will be administered an extended course of antibiotics. While inpatient, the patient will receive these antibiotics through the vein, and after discharge, the antibiotics will be taken by mouth.
- Detailed Description
Pancreatoduodenectomy (PD) is a commonly performed surgical procedure utilized in the treatment of either localized malignancies or benign conditions that involve the pancreatic head, 2nd/3rd portions of the duodenum, ampulla of Vater, and distal biliary system. Historically, there has been little improvement in the rate of postoperative pancreatic fistula (POPF), which occurs in approximately 10-40% of patients, and is influenced by a number of factors, including surgeon experience, pancreatic gland texture, pancreatic duct size, and underlying diagnosis. POPF is the leaking of enterically contaminated and amylase-rich fluid from the pancreatic-jejunal anastomosis created during PD. This leak may lead to serious complications. The concept of antibiotic mitigation prior to development of a CR-POPF in patients at higher risk of developing CR-POPF is an option that will be explored in this study.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 3
- Subject undergoing planned, elective pancreatoduodenectomy at University Hospitals Cleveland Medical Center (UH CMC) for any indication.
- Age >18 years. Pancreatoduodenectomy is rarely, if ever performed in the elective setting for the pediatric population at UH CMC. Therefore, this study will not include this small and different population of patients undergoing pancreatoduodenectomy.
- Subjects must have the ability to understand and the willingness to sign a written informed consent document.
- Creatinine Clearance greater than 40 ml/min
- Concurrent participation in another clinical trial, where participation in the proposed clinical trial that prohibits participation in this clinical trial, or where subjects would be actively receiving another investigational agent during the 90-day evaluation period of this study.
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to Piperacillin, Tazobactam, Amoxicillin, Clavulanic Acid or other agents used in this study.
- Subjects who are found to have another active infection or presumed infection at time of surgery who will be treated per standard of care with antibiotics regardless of randomization status.
- Subjects who are found to have metastatic disease at time of planned pancreatoduodenectomy, if surgery is otherwise aborted, or if total pancreatectomy is performed due to interoperative considerations
- Any subject who, while not having history of adverse reaction to similar chemical or biologic composition to Piperacillin, Tazobactam, Amoxicillin, Clavulanic Acid or other agents used in this study, develops a suspected drug reaction to the standard perioperative dose of antibiotic, prior to randomization.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Standard perioperative antibiotics Piperacillin/Tazobactam The control group will be treated according to current standard perioperative antibiotic practice, and perioperative antibiotics will not exceed 24 hours postoperatively. Extended antibiotic prophylaxis Piperacillin/Tazobactam The intervention group will receive an extended duration of current standard perioperative antibiotics, then converted to amoxicillin/clavulanic at discharge Extended antibiotic prophylaxis Amoxicillin/ Clavulanic acid The intervention group will receive an extended duration of current standard perioperative antibiotics, then converted to amoxicillin/clavulanic at discharge
- Primary Outcome Measures
Name Time Method Clinically Relevant (Grade B/C) Postoperative Pancreatic Fistula Rate 56 days To demonstrate that extended antibiotic prophylaxis in patients with intermediate/high fistula risk score who undergo PD reduces the rate of clinically relevant postoperative pancreatic fistula in the intervention group.
- Secondary Outcome Measures
Name Time Method Mortality At 90 days Rate of mortality
Index Postoperative Length of Stay At 90 days Index postoperative length of stay
Composite Length of Stay At 90 days Composite 90-day length of stay
Readmission At 90 days Rate of readmission
Delayed Gastric Emptying At 90 days Rate of delayed gastric emptying
Image-guided Drain Placement At 90 days Rate of image-guided drain placement
Postpancreatectomy Hemorrhage At 90 days Presence of postpancreatectomy hemorrhage
Superficial Surgical Site Infection At 90 days Presence of superficial surgical site infection
Deep Surgical Site Infections At 90 days Presence of deep surgical site infections
Deep Space Infections/Intra-abdominal Abscess At 90 days Presence of deep space infections/intra-abdominal abscess
Additional Drain Placement At 90 days Rate of additional drain placement
Unplanned Return to Operating Room At 90 days Measuring occurrences of unplanned return to operating room
Acute Kidney Injury At 90 days Rate of the presence of acute kidney injury
C. Difficile Colitis At 90 days Rate of the presence of C. difficile colitis
Trial Locations
- Locations (1)
University Hospitals Cleveland Medical Center
🇺🇸Cleveland, Ohio, United States