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EsophagectomyERASENCT04750096

Esophagectomy Enhanced Recovery After Surgery Protocol

An observational study of Esophagectomy, run by Raquel Ferrandis Comes at 1 site in Spain.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Despite the important advances in anaesthesia and the implementation of perioperative care, pulmonary complications in esophagectomy reach figures of between 20 and 35%, and these complications are also closely associated with the mortality rate. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Esophagectomy
How many people
100 participants
Where
1 siteSpain
Study dates
1 Sep 2020to 31 Dec 2022
Phase
Observational
Are there results?
None posted in the registry

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 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients undergoing esophagectomy due to oesophageal cancer.

Who may be able to join

  • Patients undergone esophagectomy due to neoplastic causes
  • Ages between 18 and 90
  • Programmed surgery

Who cannot join

  • Caustic esophagitis
  • Esophagectomy for stomach cancer
  • Congenital oesophageal malformations
  • Respiratory failure at the time of surgery
  • Re-interventions of esophagectomy
  • Unexpected intraoperative surgical problems

Trial locations and contacts

1 site in 1 country.

Silvia Polo, Medical specialist contact

+34 690 85 39 26

silpomar@mail.ucv.es

Silvia Polo, Medical Specialist contact

+ 34 690 85 39 26

silpomar@mail.ucv.es

Spain1 site, 1 recruiting
  • La Fe University and Polytechnic Hospital

    Valencia, 46026

    Silvia Polo, Medical specialist, + 34 690 85 39 26, silpomar@mail.ucv.es

    Raquel Ferrandis, Medical Specialist

    Recruiting

Other trials in Spain

About this study

Official title: Respiratory Failure in Esophagectomy. Results After Implantation of Enhanced Recovery After Surgery Protocol.

Despite the important advances in anaesthesia and the implementation of perioperative care, pulmonary complications in esophagectomy reach figures of between 20 and 35%, and these complications are also closely associated with the mortality rate. Factors that have been associated with the development of respiratory failure in the literature include among others the presence of previous respiratory pathology, history of smoking, malnutrition and rescue surgery.

With the aim of improving morbimortality in patients undergoing esophagectomy, a multidisciplinary protocol based on the best scientific evidence at the present time has been implemented, with actions covering both the preoperative and postoperative areas. Based on this point, a prospective study has been designed that allows us to compare the incidence of respiratory failure before and after the implementation of the protocol.

Read the detailed description

Esophageal carcinoma is the sixth leading cause of cancer death worldwide and the main treatment still remains oesophagectomy, a technique associated with a high morbidity and mortality rate. Despite the important advances in anaesthesia and the implementation of perioperative care, pulmonary complications in these patients reach figures of between 20 and 35%, and these complications are also closely associated with the mortality rate. Factors that have been associated with the development of respiratory failure in the literature include among others the presence of previous respiratory pathology, history of smoking, malnutrition and rescue surgery.

With the aim of improving morbimortality in patients undergoing oesophagectomy, a multidisciplinary protocol based on the best scientific evidence at the present time has been implemented, with actions covering both the preoperative and postoperative areas. Based on this point, a prospective study has been designed that allows us to compare the incidence of respiratory failure before and after the implementation of the protocol.

The secondary objectives are to analyse the changes produced in terms of morbimortality after the implementation of the protocol and the repercussion of these changes on the length of stay in the Resuscitation Unit.

To carry out this project, data obtained in the first instance from patients operated before the implementation of the enhanced recovery after surgery protocol will be compared with data obtained prospectively after the implementation of the protocol.

The data will be collected from the computerised and digitalised medical records of the patients on Orion Clinic® and Interspace intelligence Critical Care and Anesthesia, Philips ®. Patients operated on between 19 October 2020 and 19 October 2021 will be included consecutively. Prior to the operation, patients must sign an informed consent form to authorize the monitoring of their data during the first 30 days after the operation. These data will include:

  • Days of stay
  • Development or not of respiratory failure on initial admission, as well as the ventilatory therapy used (non-invasive and invasive) and days of mechanical ventilation
  • Fluid balance at 24 hours
  • Adequate completion of the protocol on a post-operative basis. The items of the protocol completed during the postoperative period will be detailed, taking into account the following points:
  1. Use of epidural analgesia
  2. Adequate pain control
  3. Realisation of neutral or negative balances
  4. Introduction of enteral nutrition by jejunostomy
  5. Performance of respiratory physiotherapy
  6. Use of high-flow nasal glasses with a minimum flow of 40 litres.
  7. Start of sedation on the second post-operative day
  8. Antithrombotic prophylaxis
  • The need or not for new drains and the reason for their installation will also be collected in order to evaluate the effectiveness of the transhiatal drains included in our protocol.

Data regarding re-entry will be collected on

  • Reason for re-entry
  • Evolutionary day after surgery when readmission took place (day 1 being counted as the day of esophagectomy)
  • Days in the Critical Care Unit
  • Development or not of respiratory insufficiency, and in positive cases, requirement of invasive or non-invasive mechanical ventilation and days of therapy with it.

Finally, the morbidity and mortality variables will be collected:

  • Respiratory complications: pleural effusion, atelectasis, pneumothorax, pneumonia, adult respiratory distress syndrome (ARDS).
  • The development of complications other than respiratory ones.
  • The need for reintervention and the underlying cause.
  • If exits occur, as well as the cause of death in hospital or in the first 30 days after surgery.

The data will be analysed using Statistical Package for the Social Sciences software ® (version 12).

Conditions
Esophagectomy
Keywords
Esophagectomy, enhanced recovery after surgery, acute lung injury
Medical subject headings
Acute Lung Injury

What participants receive

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

Study groups in NCT04750096
Study groupRoleWhat they receive
Esophagectomy post enhanced recovery after surgeryPatients undergoing esophagectomy due to oesophageal cancer under Enhanced Recovery After Surgery protocol.

What is being measured

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

  1. Post-operative respiratory failure

    Post-operative respiratory failure in esophagectomy after introduction of Enhanced Recovery After Surgery protocol

    Measured: 1 month

Secondary outcomes (4)
  1. Other morbidity

    Analyse changes in terms of morbidity and mortality different from respiratory failure following the implementation of the protocol. It will allow us to know the impact of the measures carried out on complications and mortality.

    Measured: 1 month

  2. Stay at ICU

    Changes produced in the resuscitation stay after the Enhanced Recovery After Surgery protocol.

    Measured: 1 month

  3. Main predisposing factors

    Main predisposing factors for the development of respiratory insufficiency.

    Measured: 1 month

  4. Respiratory failure as a prognostic factor

    Analyse the presence of respiratory failure as a prognostic factor. This allows us to know the impact of respiratory failure on the evolution of the patient.

    Measured: 1 month

Timeline

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

  1. First posted11 Feb 2021
  2. Study start1 Sep 2020
  3. Primary completion1 Sep 2022 (estimated)
  4. Study completion31 Dec 2022 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04750096
Sponsor's protocol ID
ERASE 001
Acronym
ERASE
Status last verified
Feb 2021
First submitted
10 Feb 2021
Last updated
11 Feb 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D'Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL. Benchmarking Complications Associated with Esophagectomy. Ann Surg. 2019 Feb;269(2):291-298. doi: 10.1097/SLA.0000000000002611.

    PubMed 29206677
  • Takeuchi H, Miyata H, Ozawa S, Udagawa H, Osugi H, Matsubara H, Konno H, Seto Y, Kitagawa Y. Comparison of Short-Term Outcomes Between Open and Minimally Invasive Esophagectomy for Esophageal Cancer Using a Nationwide Database in Japan. Ann Surg Oncol. 2017 Jul;24(7):1821-1827. doi: 10.1245/s10434-017-5808-4. Epub 2017 Feb 21.

    PubMed 28224366
  • van Adrichem EJ, Meulenbroek RL, Plukker JT, Groen H, van Weert E. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study. Ann Surg Oncol. 2014 Jul;21(7):2353-60. doi: 10.1245/s10434-014-3612-y. Epub 2014 Mar 7.

    PubMed 24604584
  • Armestar F, Mesalles E, Font A, Arellano A, Roca J, Klamburg J, Fernandez-Llamazares J. [Serious postoperative complications after esophagectomy for esophageal carcinoma: analysis of risk factors]. Med Intensiva. 2009 Jun-Jul;33(5):224-32. doi: 10.1016/s0210-5691(09)71756-5. Spanish.

    PubMed 19624996
  • Liu F, Wang W, Wang C, Peng X. Enhanced recovery after surgery (ERAS) programs for esophagectomy protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2018 Feb;97(8):e0016. doi: 10.1097/MD.0000000000010016.

    PubMed 29465538
  • Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014 Mar;259(3):413-31. doi: 10.1097/SLA.0000000000000349.

    PubMed 24253135
  • Lagarde SM, Maris AK, de Castro SM, Busch OR, Obertop H, van Lanschot JJ. Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg. 2007 Dec;94(12):1521-6. doi: 10.1002/bjs.5850.

    PubMed 17929231
  • van der Sluis PC, Schizas D, Liakakos T, van Hillegersberg R. Minimally Invasive Esophagectomy. Dig Surg. 2020;37(2):93-100. doi: 10.1159/000497456. Epub 2019 May 16.

    PubMed 31096214
  • Lv L, Hu W, Ren Y, Wei X. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther. 2016 Oct 31;9:6751-6762. doi: 10.2147/OTT.S112105. eCollection 2016.

    PubMed 27826201
  • Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position--experience of 130 patients. J Am Coll Surg. 2006 Jul;203(1):7-16. doi: 10.1016/j.jamcollsurg.2006.03.016.

    PubMed 16798482
  • Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, Nakamoto T, Nagasue N. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004 Nov 1;88(2):71-7. doi: 10.1002/jso.20137.

    PubMed 15499604
  • Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011 May;91(5):1494-1500; discussion 1500-1. doi: 10.1016/j.athoracsur.2010.12.036.

    PubMed 21524462
  • Kobayashi S, Kanetaka K, Nagata Y, Nakayama M, Matsumoto R, Takatsuki M, Eguchi S. Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study. BMC Surg. 2018 Mar 6;18(1):15. doi: 10.1186/s12893-018-0348-9.

    PubMed 29510754
  • Biere SS, van Berge Henegouwen MI, Bonavina L, Rosman C, Roig Garcia J, Gisbertz SS, van der Peet DL, Cuesta MA. Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial. J Thorac Dis. 2017 Jul;9(Suppl 8):S861-S867. doi: 10.21037/jtd.2017.06.61.

    PubMed 28815084
  • Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004 Nov;240(5):791-800. doi: 10.1097/01.sla.0000143123.24556.1c.

    PubMed 15492560

Questions about this trial

What is this clinical trial studying?

An observational study of Esophagectomy, run by Raquel Ferrandis Comes at 1 site in Spain.

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 6 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: status not confirmed, as of the sponsor's last update on 11 Feb 2021. 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 Spain. 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?

Results are not available in the source record.

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

Contact Silvia Polo, Medical specialist (+34 690 85 39 26, silpomar@mail.ucv.es), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Post-operative respiratory failure (time frame: 1 month). 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 NCT04750096, which also lists 18 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 11 Feb 2021.

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