Postoperative SepsisEPHASNCT04799379
Microporous Polysaccharide Hemospheres (MPH) Improving Outcome After Rectal Surgery
An observational study of Postoperative Sepsis, run by Grupo Español de Rehabilitación Multimodal at 5 sites in Spain.
Trial summary
Multi-center, prospective, cohort study, of patients scheduled for elective rectal surgery who received absorbable hemostatic powder to assess whether it can improve patient postoperative outcomes, reduce usage of drains and prove to be cost-effective. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Postoperative Sepsis
- What is being tested?
- microporous polysaccharide hemospheres (MPH) agent in rectal surgery
- How many people
- 130 participants
- Where
- 5 sitesSpain
- Study dates
- 1 Apr 2021to 30 Jun 2024
- How long will I take part?
- 60 Days
- 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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Adult patients (aged >18 years) with a diagnosis of malignant rectal cancer who are scheduled for radical surgery. This study will be conducted in 12 Spanish general hospitals, which are selected on the basis of having established an enhanced recovery protocol that complies with the recommendations of the Aragon Health Sciences Institute (IACS) and Spanish National Health Service (https://portal.guiasalud.es/wpcontent/uploads/2019/10/viaclinica-rica_english.pdf)
Who may be able to join
- All adult patients (aged >18 years) with a diagnosis of malignant rectal cancer who are scheduled for radical surgery (anterior resection). Informed consent will be obtained from all subjects, who will participate in the study voluntarily.
Who cannot join
- Patient refusal, patients undergoing emergency surgery, patients under 18 years of age, existence of other concomitant surgical processes. Previous chemo-radiotherapy. Ileostomy or colostomy. Patients that have receive a drain.
Trial locations and contacts
5 sites in 1 country.
5 sites in 1 country
Spain5 sites
Hospital de la RIBERA
Alzira, Valencia
Hospital General Universitario de Elche
Elche, Alicante
Hospital Jimenz diaz
Madrid
Hospital Universitario Infanta Leonor
Madrid
Hospital Clínico Universitario Lozano Blesa
Zaragoza
About this study
Official title: Evaluation of Microporous Polysaccharide Hemospheres (MPH) Agent in Preventing Postoperative Complications After Rectal Surgery (EPHAS Study).
Multi-center, prospective, cohort study, of patients scheduled for elective rectal surgery who received absorbable hemostatic powder to assess whether it can improve patient postoperative outcomes, reduce usage of drains and prove to be cost-effective. This cohort will be compared to a previously studied cohort using drains (Power and IMPRICA study) with comparable patient characteristics.
The primary endpoint of the study is: postoperative pelvic sepsis within 60 postoperative days including anastomotic leakage, pelvic abscess and peritonitis.
Secondary endpoints: postoperative morbidities, rate of reoperation and length of hospitalization.
Read the detailed description
Multimodal surgical rehabilitation, also known as Enhanced Recovery After Surgery, entails the application of a series of perioperative procedure measures and strategies aimed at patients who are going to undergo a surgical procedure with the objective of reducing secondary stress caused by the surgical intervention and thus achieve enhanced recovery of the patient and decrease complications and mortality.
ERAS protocols are care programs based on scientific evidence, encompassing all aspects of patient care and requiring multidisciplinary management, with the participation of diverse specialists1. Starting at the diagnosis, their aim is to recognize patients' individual needs to optimize their treatment before, during and after surgery. The close collaboration of all specialists participating in the process, as well as of the actual patients and their relatives has proved to be essential.
The Multimodal Rehabilitation Programmes (MRP) or Enhanced Recovery Programmes (ERAS) review traditional perioperative procedure practices, evaluating the specific key points of each type of surgery and analysing their scientific evidence. MRPs have shown, in cents that have routinely adopted them, a significant improvement in the patient's quality of life. Furthermore, MRPs significantly reducing the hospital stay and potential complications associated with hospitalisation2, being the anastomotic leak (AL) the most serious of them.
Total mesorectal excision (TME) and bowel restoration is currently the standard treatment for middle to low rectal cancer. However, TME has been shown to be associated with high anastomotic leakage with a reported incidence of up to 24%, reaching 50% when clinically silent radiographic leaks are considered3.
Despite a large number of studies in the literature that have investigated risk factors, the fundamental causes of AL remain unclear. In this sense, according to enhanced recovery after surgery (ERAS) protocols4, pelvic drain should not be used routinely as it may cause patient discomfort and prolong hospitalization. Moreover, drain itself is also a potential site of infection especially if open or passive drainage system is used.
Even based in the best available evidence, ERAS protocols have important implementation problems because they have to put up with traditional attitudes. In this sense, many surgeons still advocate the use of a prophylactic pelvic drain because they believe that fluid collection in the pelvis could be a potential source of contamination and thereby weakening anastomotic integrity and healing.
In a recent study from the Spanish group GERM2, avoidance of drains was achieved only in 34.7% of patients undergoing elective colorectal surgery. ERAS centres had a greater avoidance of drains vs non-ERAS centres (38.6% vs 28.3%), although most patients still received drains. More relevant, avoidance of drainage was associated with a significant reduction in moderate to severe complications.
We believe that it is more than justified to try new options that help surgeons reduce the use of drains. One of these, is the use of hemostatic agents. Some topical hemostats may theoretically be of benefit due to its claimed lymphostatic properties.
Published data for this is sparse, but some studies, have shown statistically significant reduction of fluid collection after using Arista®AH5.
Arista is a plant-based, flowable powder engineered to rapidly dehydrate blood, enhancing clotting on contact. Arista facilitates the formation of a highly resilient, natural clot within just a few minutes regardless of the patient's coagulation status. Arista® is fully absorbable within 24 to 48 hours of application, and because Arista degrades rapidly, it does not promote infection.
This study has been designed to support the working hypothesis that Arista® placed intraoperatively into the dissected pelvic area could reduce sepsis and postoperative anastomotic leakage. We choose to study Arista® for a theoretical reason: it contains microporous polysaccharide hemospheres (MPHs). MPHs not only activate the coagulation cascade but they cause tissue desiccation which presumably seals capillaries and could theoretically also seal small lymph vessels left open by electrosurgical devices.
Study assumptions: Arista spread on the pelvic floor at the end of surgery may allow to
- close small holes and prevent fluid from penetrating into the pelvic floor, thereby avoiding AL
- facilitate the avoidance of drains
- Conditions
- Postoperative Sepsis
- Being tested
- microporous polysaccharide hemospheres (MPH) agent in rectal surgery
- Keywords
- Rectal surgery, Pelvic drain, microporous polysaccharide hemospheres
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
microporous polysaccharide hemospheres (MPH) agent in rectal surgeryDrug
Use of microporous polysaccharide hemospheres (MPH) agent in patients after rectal surgery to avoid pelvic collections and the use of any drain
What is being measured
The primary outcome is the main question the study is designed to answer.
postoperative pelvic sepsis including anastomotic leakage, pelvic abscess and peritonitis.
% patients with organ-space infection or anastomotic leak
Measured: 60 days
Secondary outcomes (3)
postoperative morbidities
% Patients with at least one complication related to the surgical intervention
Measured: 60 days
rate of reoperation
% patients requiring reoperation for any cause
Measured: 60 days
Hospital stay
Total number of days of stay included pre and postoperative.
Measured: 60 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Mar 2021
- Study start1 Apr 2021
- Primary completion31 Dec 2023
- Study completion30 Jun 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Postoperative SepsisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- 130 participants (actual)
- Target duration
- 60 Days
Sponsor and investigators
- Lead sponsor
- Grupo Español de Rehabilitación Multimodal
- Sponsor type
- University, hospital or other
- Collaborators
- Universidad de Zaragoza, Aragon Health Science Institute
- Responsible party
- Sponsor
- Investigators
- Javier Blanco, PhD, Principal investigator, Hospital de la Ribera
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04799379
- Sponsor's protocol ID
- GERM-EPHAS
- Acronym
- EPHAS
- Status last verified
- Jul 2024
- First submitted
- 26 Feb 2021
- Last updated
- 16 Jul 2024
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Ruiz-Tovar J, Sanchez-Santos R, Martin-Garcia-Almenta E, Garcia Villabona E, Hernandez AM, Hernandez-Matias A, Ramirez JM; grupo de Trabajo de Cirugia Bariatrica del Grupo Espanol de Rehabilitacion Multimodal (GERM). Enhanced recovery after bariatric surgery. Cir Esp (Engl Ed). 2019 Dec;97(10):551-559. doi: 10.1016/j.ciresp.2019.05.003. Epub 2019 Jun 18. English, Spanish.
PubMed 31221424Ripolles-Melchor J, Ramirez-Rodriguez JM, Casans-Frances R, Aldecoa C, Abad-Motos A, Logrono-Egea M, Garcia-Erce JA, Camps-Cervantes A, Ferrando-Ortola C, Suarez de la Rica A, Cuellar-Martinez A, Marmana-Mezquita S, Abad-Gurumeta A, Calvo-Vecino JM; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg. 2019 Aug 1;154(8):725-736. doi: 10.1001/jamasurg.2019.0995.
PubMed 31066889Cavaliere D, Popivanov G, Cassini D, Cirocchi R, Henry BM, Vettoretto N, Ercolani G, Solaini L, Gerardi C, Tabakov M, Tomaszewski KA. Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. Int J Colorectal Dis. 2019 Jun;34(6):973-981. doi: 10.1007/s00384-019-03276-4. Epub 2019 Apr 25.
PubMed 31025093Luong J, Milanese E, Fortino J, Vetto JT. Reduction of lymphocele rate in patients undergoing sentinel node biopsy for melanoma by intraoperative placement of plant-based hemostatic powder: Results of a prospective trial. Am J Surg. 2019 May;217(5):878-881. doi: 10.1016/j.amjsurg.2019.02.016. Epub 2019 Feb 14.
PubMed 30799018Grupo de trabajo. Vía Clínica de Recuperación Intensificada en Cirugía Abdominal (RICA). Vía clínica de recuperación intensificada en cirugía abdominal (RICA) Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud. 2014 Available from: http://portal.guiasalud.es/contenidos/iframes/documentos/ opbe/2015-07/ViaClinica-RICA.pdf
Study at a glance
From the registry record, last updated by the sponsor on 16 Jul 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Microporous Polysaccharide Hemospheres (MPH) Agent in Preventing Postoperative Complications After Rectal Surgery (EPHAS Study).
- ClinicalTrials.gov ID
- NCT04799379
- Acronym / sponsor ID
- EPHAS / GERM-EPHAS
- Conditions
- Postoperative Sepsis
- Keywords
- Rectal surgery, Pelvic drain, microporous polysaccharide hemospheres
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 130 participants (actual)
- Lead sponsor
- Grupo Español de Rehabilitación MultimodalUniversity, hospital or other
- Collaborators
- Universidad de Zaragoza, Aragon Health Science Institute
- Study start
- 1 Apr 2021 (actual)
- Primary completion
- 31 Dec 2023 (actual)
- Study completion
- 30 Jun 2024 (actual)
- First posted
- 16 Mar 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Multi-center, prospective, cohort study, of patients scheduled for elective rectal surgery who received absorbable hemostatic powder to assess whether it can improve patient postoperative outcomes, reduce usage of drains and prove to be cost-effective. This cohort will be compared to a previously studied cohort using drains (Power and IMPRICA study) with comparable patient characteristics.
The primary endpoint of the study is: postoperative pelvic sepsis within 60 postoperative days including anastomotic leakage, pelvic abscess and peritonitis.
Secondary endpoints: postoperative morbidities, rate of reoperation and length of hospitalization.
Detailed description
Multimodal surgical rehabilitation, also known as Enhanced Recovery After Surgery, entails the application of a series of perioperative procedure measures and strategies aimed at patients who are going to undergo a surgical procedure with the objective of reducing secondary stress caused by the surgical intervention and thus achieve enhanced recovery of the patient and decrease complications and mortality.
ERAS protocols are care programs based on scientific evidence, encompassing all aspects of patient care and requiring multidisciplinary management, with the participation of diverse specialists1. Starting at the diagnosis, their aim is to recognize patients' individual needs to optimize their treatment before, during and after surgery. The close collaboration of all specialists participating in the process, as well as of the actual patients and their relatives has proved to be essential.
The Multimodal Rehabilitation Programmes (MRP) or Enhanced Recovery Programmes (ERAS) review traditional perioperative procedure practices, evaluating the specific key points of each type of surgery and analysing their scientific evidence. MRPs have shown, in cents that have routinely adopted them, a significant improvement in the patient's quality of life. Furthermore, MRPs significantly reducing the hospital stay and potential complications associated with hospitalisation2, being the anastomotic leak (AL) the most serious of them.
Total mesorectal excision (TME) and bowel restoration is currently the standard treatment for middle to low rectal cancer. However, TME has been shown to be associated with high anastomotic leakage with a reported incidence of up to 24%, reaching 50% when clinically silent radiographic leaks are considered3.
Despite a large number of studies in the literature that have investigated risk factors, the fundamental causes of AL remain unclear. In this sense, according to enhanced recovery after surgery (ERAS) protocols4, pelvic drain should not be used routinely as it may cause patient discomfort and prolong hospitalization. Moreover, drain itself is also a potential site of infection especially if open or passive drainage system is used.
Even based in the best available evidence, ERAS protocols have important implementation problems because they have to put up with traditional attitudes. In this sense, many surgeons still advocate the use of a prophylactic pelvic drain because they believe that fluid collection in the pelvis could be a potential source of contamination and thereby weakening anastomotic integrity and healing.
In a recent study from the Spanish group GERM2, avoidance of drains was achieved only in 34.7% of patients undergoing elective colorectal surgery. ERAS centres had a greater avoidance of drains vs non-ERAS centres (38.6% vs 28.3%), although most patients still received drains. More relevant, avoidance of drainage was associated with a significant reduction in moderate to severe complications.
We believe that it is more than justified to try new options that help surgeons reduce the use of drains. One of these, is the use of hemostatic agents. Some topical hemostats may theoretically be of benefit due to its claimed lymphostatic properties.
Published data for this is sparse, but some studies, have shown statistically significant reduction of fluid collection after using Arista®AH5.
Arista is a plant-based, flowable powder engineered to rapidly dehydrate blood, enhancing clotting on contact. Arista facilitates the formation of a highly resilient, natural clot within just a few minutes regardless of the patient's coagulation status. Arista® is fully absorbable within 24 to 48 hours of application, and because Arista degrades rapidly, it does not promote infection.
This study has been designed to support the working hypothesis that Arista® placed intraoperatively into the dissected pelvic area could reduce sepsis and postoperative anastomotic leakage. We choose to study Arista® for a theoretical reason: it contains microporous polysaccharide hemospheres (MPHs). MPHs not only activate the coagulation cascade but they cause tissue desiccation which presumably seals capillaries and could theoretically also seal small lymph vessels left open by electrosurgical devices.
Study assumptions: Arista spread on the pelvic floor at the end of surgery may allow to
- close small holes and prevent fluid from penetrating into the pelvic floor, thereby avoiding AL
- facilitate the avoidance of drains
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Target follow-up
- 60 Days
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Adult patients (aged >18 years) with a diagnosis of malignant rectal cancer who are scheduled for radical surgery. This study will be conducted in 12 Spanish general hospitals, which are selected on the basis of having established an enhanced recovery protocol that complies with the recommendations of the Aragon Health Sciences Institute (IACS) and Spanish National Health Service (https://portal.guiasalud.es/wpcontent/uploads/2019/10/viaclinica-rica_english.pdf)
Key inclusion criteria (1 listed)
- All adult patients (aged >18 years) with a diagnosis of malignant rectal cancer who are scheduled for radical surgery (anterior resection). Informed consent will be obtained from all subjects, who will participate in the study voluntarily.
Key exclusion criteria (1 listed)
- Patient refusal, patients undergoing emergency surgery, patients under 18 years of age, existence of other concomitant surgical processes. Previous chemo-radiotherapy. Ileostomy or colostomy. Patients that have receive a drain.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| microporous polysaccharide hemospheres (MPH) agent in rectal surgeryUse of microporous polysaccharide hemospheres (MPH) agent in patients after rectal surgery to avoid pelvic collections and the use of any drain | Drug | – |
Primary outcome
postoperative pelvic sepsis including anastomotic leakage, pelvic abscess and peritonitis.
Time frame: 60 days
% patients with organ-space infection or anastomotic leak
3 secondary outcomes
postoperative morbidities
Time frame: 60 days
rate of reoperation
Time frame: 60 days
Hospital stay
Time frame: 60 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Jul 2024.
- Background: PubMed 31221424Ruiz-Tovar J, Sanchez-Santos R, Martin-Garcia-Almenta E, Garcia Villabona E, Hernandez AM, Hernandez-Matias A, Ramirez JM; grupo de Trabajo de Cirugia Bariatrica del Grupo Espanol de Rehabilitacion Multimodal (GERM). Enhanced recovery after bariatric surgery. Cir Esp (Engl Ed). 2019 Dec;97(10):551-559. doi: 10.1016/j.ciresp.2019.05.003. Epub 2019 Jun 18. English, Spanish.
- Background: PubMed 31066889Ripolles-Melchor J, Ramirez-Rodriguez JM, Casans-Frances R, Aldecoa C, Abad-Motos A, Logrono-Egea M, Garcia-Erce JA, Camps-Cervantes A, Ferrando-Ortola C, Suarez de la Rica A, Cuellar-Martinez A, Marmana-Mezquita S, Abad-Gurumeta A, Calvo-Vecino JM; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg. 2019 Aug 1;154(8):725-736. doi: 10.1001/jamasurg.2019.0995.
- Background: PubMed 31025093Cavaliere D, Popivanov G, Cassini D, Cirocchi R, Henry BM, Vettoretto N, Ercolani G, Solaini L, Gerardi C, Tabakov M, Tomaszewski KA. Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. Int J Colorectal Dis. 2019 Jun;34(6):973-981. doi: 10.1007/s00384-019-03276-4. Epub 2019 Apr 25.
- Background: PubMed 30799018Luong J, Milanese E, Fortino J, Vetto JT. Reduction of lymphocele rate in patients undergoing sentinel node biopsy for melanoma by intraoperative placement of plant-based hemostatic powder: Results of a prospective trial. Am J Surg. 2019 May;217(5):878-881. doi: 10.1016/j.amjsurg.2019.02.016. Epub 2019 Feb 14.
- BackgroundGrupo de trabajo. Vía Clínica de Recuperación Intensificada en Cirugía Abdominal (RICA). Vía clínica de recuperación intensificada en cirugía abdominal (RICA) Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud. 2014 Available from: http://portal.guiasalud.es/contenidos/iframes/documentos/ opbe/2015-07/ViaClinica-RICA.pdf
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Javier Blanco, PhD principal investigator
Hospital de la Ribera
5 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Postoperative Sepsis, run by Grupo Español de Rehabilitación Multimodal at 5 sites 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 1 inclusion and 1 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 16 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 5 sites 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
postoperative pelvic sepsis including anastomotic leakage, pelvic abscess and peritonitis. (time frame: 60 days). 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 NCT04799379, which also lists 5 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 16 Jul 2024.