Surgical Treatment of Colorectal Cancer: Analysis of the Influence of an Enhanced Recovery Protocol on Long-term Oncological Outcomes.
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 750
- 试验地点
- 12
- 主要终点
- Overall Survival
研究概览
简要总结
The main objective of this study is to analyze the impact on three years survival of an enhanced recovery program (PRI) after radical surgery for colorectal cancer. As secondary objectives, we propose to analyze the weight of each of the predefined items in the oncological results as well as the quality of life.
We design a multicentric prospective cohort study in people older than 18 years who are going to be operated on for colorectal cancer. 12 hospitals are being selected due to have a PRI implanted according to the RICA pathway published by the Spanish National Health Service. As stated by the literature, the intervention group will be formed for those hospitals with a minimum implementation level of 70% of the PRI and the control group will be the centers that do not reach this level of implementation. Compliance will be studied with 21 key performance indicators and results are analyzed with cancer survival indicators: Overall survival, cancer-specific survival and relapse-free survival). We will also study the time to recurrence, perioperative morbi-mortality, hospital stay and quality of life with the EQ-5D validated questionary.
To create comparable treatment and control groups, the Propensity Index method will be used. To study each variable, multivariate regression will be used. Kaplan-Meier will be used for survival and the log-rank test for comparisons. Significance will be considered if p <0.05 (two tails).
详细描述
Subjects of study (inclusion criteria): All patients over 18 years of age who will be operated on a scheduled basis for colorectal cancer within an intensified recovery program (PRI) and who do not present any exclusion criteria.
Exclusion Criteria: - Urgent surgery; -Existence of other concomitant surgical processes; -Patients diagnosed in stage IV cancer; -Patients who refuse to participate.
Participating hospitals: Selected for their interest in intensified recovery and for having established a multidisciplinary team with the program (PRI) for colorectal surgery recommended by the Spanish Ministry of Health. Each center will select from the multidisciplinary team the researchers who will be part of this project as collaborators, ideally the facilitators of the PRI program in that center.
Variables: Patients will be recruited by local researchers from the Anesthesiology and Resuscitation and/or General Surgery services of each participating center before performing the surgical intervention. Informed consent will be requested from all subjects who voluntarily participate in the study.
- Compliance: As we have commented before and according to the literature, we will define a hospital with an intensified recovery program (PRI) that has a consensus protocol, based on evidence, multidisciplinary, with the support of the center (management) and that has fulfilled more than 70% of the protocol (annex 1) according to the process indicators. The rest of the hospitals will be considered a non-PRI hospital.
- Demography: Age, sex, BMI, smoking and fitness level of the American Society of Anesthesiologists (ASA). BMI in the surgical indication. Blood transfusion.
- Comorbidities: Presence of hypertension, diabetes mellitus, coronary artery disease, heart failure, cirrhosis, stroke or transient ischemic attack, COPD / Asthma, atrial fibrillation, heart failure, OSAS. Anemia
- Related to Surgery and Treatment: Date IQ. Surgical procedure, approach, duration of surgery, estimated bleeding. Curative surgery (R0) or non-R0 (R1-R2). Adjuvant chemotherapy Adjuvant radiotherapy Perioperative transfusion.
- Variables related to staging: Tumor typology. Growth pattern. Degree of differentiation. Presence of Vascular / lymphatic / perineural invasion / Satellites. Margin affectation. Seal ring cells. K-ras. T tumor piece. No tumor piece. Tumor m. Tumor stage according to AJCC classification.
- Related to the follow-up:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients over 18 years of age who will be operated on a scheduled basis for colorectal cancer
排除标准
- •- Urgent surgery; -Existence of other concomitant surgical processes; -Patients diagnosed in stage IV cancer; -Patients who refuse to participate.
结局指标
主要结局
Overall Survival
时间窗: 5 years
patients alive from surgery to the last control
Disease-free survival
时间窗: 5 years
number of patients alive and without cancer recurrence from the intervention period until the end of follow-up
Disease recurrence
时间窗: 5 years
detected from the day of the intervention until the end of follow-up
次要结局
- Compliance of individual items of the protocol(5 years)
- Quality of Life (QOL)(5 years)
- Patient reported outcoms (PROs)(5 years)