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Length of StayNCT02687412

Fast-track Surgery After Gynecological Oncology Surgery

A study testing pre-operative assessment, counseling and education, Preoperative nutritional drink up to 4 h prior to surgery and bowel preparation in people with Length of Stay and Postoperative Complications, run by Ling Cui at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Fast-track surgery (FTS) pathway, also known as enhanced recovery after surgery (ERAS), FTS is a multidisciplinary approach aiming to accelerate recovery, reduce complications, minimize hospital stay without an increased readmission rate and reduce healthcare costs, all without compromising patient safety. Read more about this study

Who is it for?
Ages 18 to 70 years, women only
Conditions the study is for
Length of Stay, Postoperative Complications, CRP
What is being tested?
pre-operative assessment, counseling and education, Preoperative nutritional drink up to 4 h prior to surgery and bowel preparation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
107 participants
Where
1 siteChina
Study dates
21 Nov 2016to 21 Mar 2018
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients scheduled for gynecological oncology surgery(including radical hysterectomy add lymphadenectomy, hysterectomy add lymphadenectomy and cytoreductive)
  • Aged 18 years or older
  • Signed informed consent provided

Who cannot join

  • Patients with a documented infection at the time of operation
  • Aged 71 years or older
  • Patients with ileus at the time of operation
  • Patients with hypocoagulability
  • Patients with psychosis, Alcohol dependence or drug abuse history
  • Patients with primary nephrotic or hepatic disease
  • Patients with severe hypertension systolic pressure≥160mmHg, diastolic pressure>90mmHg

Trial locations and contacts

1 site in 1 country.

China1 site
  • LinShuangfeng

    Leshan, Sichuan, 610000

Other trials in China

About this study

Official title: Fast-track Surgery After Gynaecological Oncological Surgery

Fast-track surgery (FTS) pathway, also known as enhanced recovery after surgery (ERAS), FTS is a multidisciplinary approach aiming to accelerate recovery, reduce complications, minimize hospital stay without an increased readmission rate and reduce healthcare costs, all without compromising patient safety. It has been used successfully in non-malignant gynecological surgery, but it has been proven to be especially effective in elective colorectal surgery. However, no consensus guideline has been developed for gynecological oncology surgery although surgeons have attempted to introduce slightly modified FTS programmes for patients undergoing such surgery. NO randomised controlled trials for now.

The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. There is a existing research showed FTS in gynecological oncology provide early hospital discharge after gynaecological surgery meanwhile with high levels of patient satisfaction.

The aim of this study is to identify patients following a FTS program who have been discharged earlier than anticipated after major gynaecological/gynaecological oncologic surgery and analyze the complication after surgery.

Read the detailed description

Methods/Design

Comparison of Fast-Track (FT) and traditional management protocols. the primary endpoints is length of hospitalization post-operation (d, mean±SD). It was calculated by the difference between date of discharge and date of surgery. The secondary endpoints are complications in both groups are assessed during the first 21 days postoperatively. Including infection(wound infection, lung infection, intraperitoneal infection, operation space infection), postoperative nausea and vomiting (PONV) , ileus, postoperative hemorrhage, postoperative thrombosis and APACHE II score.

The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. NO randomised controlled trials for now. The aim of this study is to compare the LOS (Length of hospitalization post-operation) after the major gynaecological/gynaecological oncologic surgery and analyze the complication after surgery. This trial can show whether the FTS program can achieve early hospital discharge after gynaecological surgery meanwhile with low levels of complications.

Being tested
pre-operative assessment, counseling and education, Preoperative nutritional drink up to 4 h prior to surgery, bowel preparation, preoperative treatment with carbohydrates, fast solid
Keywords
Fast-track surgery, Gynecological oncology, Hospitalization post-operation, Complication
Medical subject headings
Postoperative Complications

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • pre-operative assessment, counseling and educationProcedure or surgery

    pre-operative assessment, counseling and FT management education

  • Preoperative nutritional drink up to 4 h prior to surgeryProcedure or surgery

    Preoperative nutritional drink up to 4 h prior to surgery mechanical bowl preparation should not be used

  • bowel preparationProcedure or surgery

    patients are not received mechanical bowel preparation, only oral intestinal cleaner 12 h pre-operation can be accepted, but no need of liquid stool

  • preoperative treatment with carbohydratesProcedure or surgery

    preoperative treatment with carbohydrates (patients without diabetes).

  • fast solidProcedure or surgery

    fast solid food before 6 h and liquid food Intake of clear fluids 2 h before anaesthesia;

  • avoiding hypothermiaProcedure or surgery

    avoiding hypothermia, keeping the intra-operative lowtemperature at 36 ±0.5 degree centigrade; antiemetics at end of anaesthesia.

  • Postoperative glycaemic controlProcedure or surgery

    Postoperative glycaemic control;

  • postoperative nausea and vomiting (PONV) control;Procedure or surgery

  • early postoperative dietProcedure or surgery

    early postoperative diet(3-6 h after surgery, patients resumed a liquid diet, 12 h after surgery patients began to take solid diet).

  • pre-operative fasting at least 8hProcedure or surgery

  • bowel preparation for traditional surgeryProcedure or surgery

    Oral bowel preparations or mechanical bowl until liquid stool

  • began to take solid diet after anal exhaustProcedure or surgery

    6 h after surgery, patients resumed a liquid diet, patients began to take solid diet after anal exhaust

Study groups in NCT02687412
Study groupRoleWhat they receive
Fast-track SurgeryExperimentalPre-operative: Assessment, counseling and education; preoperative nutritional drink up to 4 h prior to surgery, bowel preparation, only oral intestinal cleaner,antimicrobial prophylaxis and skin preparation; preoperative treatment with carbohydrates (patients without diabetes). Intraoperative : fast solid food before 6 h and liquid food Intake of clear fluids 2 h before anaesthesia; avoiding hypothermia keeping temperature at 36 ±0.5℃, antiemetics at end of anaesthesia. Post-operative : Postoperative glycaemic control; postoperative nausea and vomiting (PONV) control; early postoperative diet(3-6 h after surgery).
Receives: Procedure: pre-operative assessment, counseling and education; Procedure: Preoperative nutritional drink up to 4 h prior to surgery; Procedure: bowel preparation; Procedure: preoperative treatment with carbohydrates; Procedure: fast solid; Procedure: avoiding hypothermia; Procedure: Postoperative glycaemic control; Procedure: postoperative nausea and vomiting (PONV) control;; Procedure: early postoperative diet
Traditional surgeryOtherpre-operative assessment:pre-operative fasting at least 8h, bowel preparation for traditional surgery, Antimicrobial prophylaxis and skin preparation or mechanical bowl until liquid stool Intraoperative: keeping the intra-operative lowtemperature at 34.7±0.6 degree centigrade. Post-operative: 6 h after surgery, patients resumed a liquid diet, patients began to take solid diet after anal exhaust
Receives: Procedure: pre-operative fasting at least 8h; Procedure: bowel preparation for traditional surgery; Procedure: began to take solid diet after anal exhaust

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Length of Hospitalization Post-operation

    days from operation date to discharge date

    Measured: up to 12 months

  2. The Total Cost (RMB)

    The total cost from hospitalization

    Measured: 12 month

Secondary outcomes (9)
  1. CRP

    C-Reactive protein mg/L

    Measured: up to 12 months

  2. Number of Participants With Complications

    Count of patients with complications in both groups are assessed during the first 21 days postoperatively. Including infection(wound infection, lung infection, intraperitoneal infection, operation space infection), postoperative nausea and vomiting (PONV) , ileus, postoperative hemorrhage, postoperative thrombosis.

    Measured: up to 12 months

  3. Number of Participants With Infection,

    infection(wound infection, lung infection, intraperitoneal infection, operation space infection)

    Measured: up to 12 months

  4. Number of Participants With Postoperative Nausea and Vomiting (PONV)

    it was recognized that nausea and vomiting are common side effects of surgical recovery

    Measured: up to 12 months

  5. Number of Participants With Ileus

    is a disruption of the normal propulsive ability of the gastrointestinal tract

    Measured: up to 12 months

  6. Number of Participants With Postoperative Haemorrhage

    Evidence of blood loss from drains or based on ultrasonography

    Measured: up to 12 months

  7. Number of Participants With Postoperative Thrombosis

    Evidence of blood thrombosis of participants after surgery

    Measured: up to 12 months

  8. PCT Calcitonin Postoperative

    value of calcitonin postoperative

    Measured: 12 month

  9. Cost of Surgical Therapy

    Cost of surgical therapy (RMB)

    Measured: 12 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Feb 2016 (estimated)
  2. Study start21 Nov 2016
  3. Primary completion2 Sep 2017
  4. Study completion21 Mar 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
prospective randomised controlled trial
Masking
None (open label)
Enrolment
107 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02687412
Sponsor's protocol ID
SichuanCHRI
Status last verified
Aug 2019
First submitted
2 Feb 2016
Last updated
26 Sep 2019
Data monitoring committee
No
Individual data sharing
No

Publications

  • Kehlet H. Fast-track colorectal surgery. Lancet. 2008 Mar 8;371(9615):791-3. doi: 10.1016/S0140-6736(08)60357-8. No abstract available.

    PubMed 18328911
  • Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002 Jun;183(6):630-41. doi: 10.1016/s0002-9610(02)00866-8.

    PubMed 12095591
  • Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg. 2007;24(6):441-9. doi: 10.1159/000108327. Epub 2007 Sep 13.

    PubMed 17851238
  • Acheson N, Crawford R. The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial. BJOG. 2011 Feb;118(3):271-3. doi: 10.1111/j.1471-0528.2010.02811.x. No abstract available.

    PubMed 21226823
  • Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995 Mar 25;345(8952):763-4. doi: 10.1016/s0140-6736(95)90643-6.

    PubMed 7891489
  • Carter J, Szabo R, Sim WW, Pather S, Philp S, Nattress K, Cotterell S, Patel P, Dalrymple C. Fast track surgery: a clinical audit. Aust N Z J Obstet Gynaecol. 2010 Apr;50(2):159-63. doi: 10.1111/j.1479-828X.2009.01134.x.

    PubMed 20522073
  • Bona S, Molteni M, Rosati R, Elmore U, Bagnoli P, Monzani R, Caravaca M, Montorsi M. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol. 2014 Dec 14;20(46):17578-87. doi: 10.3748/wjg.v20.i46.17578.

    PubMed 25516673
  • Carter J. Fast-track surgery in gynaecology and gynaecologic oncology: a review of a rolling clinical audit. ISRN Surg. 2012;2012:368014. doi: 10.5402/2012/368014. Epub 2012 Dec 24.

    PubMed 23320193
  • Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005 Jun;24(3):466-77. doi: 10.1016/j.clnu.2005.02.002. Epub 2005 Apr 21.

    PubMed 15896435
  • Kehlet H. Multimodal approach to postoperative recovery. Curr Opin Crit Care. 2009 Aug;15(4):355-8. doi: 10.1097/MCC.0b013e32832fbbe7.

    PubMed 19617822
  • Kehlet H. Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg. 2011 Jun;396(5):585-90. doi: 10.1007/s00423-011-0790-y. Epub 2011 Apr 6.

    PubMed 21468643
  • Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008 Aug;248(2):189-98. doi: 10.1097/SLA.0b013e31817f2c1a.

    PubMed 18650627
  • Kranke P, Redel A, Schuster F, Muellenbach R, Eberhart LH. Pharmacological interventions and concepts of fast-track perioperative medical care for enhanced recovery programs. Expert Opin Pharmacother. 2008 Jun;9(9):1541-64. doi: 10.1517/14656566.9.9.1541.

    PubMed 18518784
  • Lin YS. Preliminary results of laparoscopic modified radical hysterectomy in early invasive cervical cancer. J Am Assoc Gynecol Laparosc. 2003 Feb;10(1):80-4. doi: 10.1016/s1074-3804(05)60239-3.

    PubMed 12554999
  • Lu D, Wang X, Shi G. Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev. 2015 Mar 19;2015(3):CD008239. doi: 10.1002/14651858.CD008239.pub4.

    PubMed 25789452

Questions about this trial

What is this clinical trial studying?

A study testing pre-operative assessment, counseling and education, Preoperative nutritional drink up to 4 h prior to surgery and bowel preparation in people with Length of Stay and Postoperative Complications, run by Ling Cui at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Sep 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Length of Hospitalization Post-operation (time frame: up to 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02687412, which also lists 24 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Sep 2019.

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