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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT06009224
Other study ID # 2022-1204
Secondary ID
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date September 1, 2023
Est. completion date December 31, 2025

Study information

Verified date August 2023
Source Asan Medical Center
Contact Dae Wook Hwang, M.D., PhD
Phone 82230103939
Email drdwhwang@gmail.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Enhanced Recovery After Surgery (ERAS) is not a program that aims to reduce postoperative hospital stay, but the multimodal strategies that aim to attenuate the loss of, and improve the restoration of, functional capacity after surgery on evidence-based medicine. The benefits of ERAS are proven in many surgical procedures, such as upper gastrointestinal surgery and colorectal surgery. Investigators performed Randomized Controlled Trials to evaluate the non-inferiority of modified ERAS protocol for pancreaticoduodenectomy (PD) by introducing standardized pre- and post-operative treatment based on ERAS treatment guidelines (ERAS on PD, Research Institute Clinical Progress, 2014-0961; ClinicalTrials.gov, NCT02372331). As a result of the study, the ERAS protocol proved to be non-inferior to the existing pre- and post-operative treatment in terms of surgical complications, mortality, hospital stay, total hospital cost, and most nutritional indicators. However, the previous study did not include a few important intraoperative items such as epidural analgesia and fluid balance among the main items of the ERAS protocol. This trial aims to evaluate the clinical results by applying the complete ERAS protocol.


Description:

This study was a single-institution, randomized controlled clinical trial to test the superiority of Enhanced Recovery After Surgery (ERAS) protocol for patients with pancreaticoduodenectomy (PD). This study will be conducted on adult patients who are planning to undergo pancreaticoduodenectomy for the treatment of periampullary disease for 12 months after the start of the study. Based on the results of the previous study which choose the functional recovery date as a primary outcome (control group; 9.0 ± 4.3 days, intervention group; 7.6 ± 4.3 days), a total of 334 patients (167 patients in each group) will be enrolled when calculated with power 0.8, α = 0.05, a two-tailed test, and a 10% withdrawal rate. Investigators plan to randomize patients covered by the existing ERAS program to the control group and patients covered by the full ERAS protocol to the experimental group. Investigators plan to observe the clinical outcomes up to 3 months after surgery. The primary outcome is the functional recovery date, and secondary outcomes are the postoperative complication rate, postoperative mortality, and readmission rate. All subjects who were randomized and received any study intervention were obliged to follow the study protocol and monitored for best compliance, per-protocol set or safety set was not defined differently.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 334
Est. completion date December 31, 2025
Est. primary completion date June 30, 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years to 80 Years
Eligibility Inclusion Criteria: - Age: 18 to 80 years old - Performance: Eastern Cooperative Oncology Group (ECOG) 0-2 - Resectable or borderline resectable malignant tumor or borderline malignant tumor on the periampullary area - No distant metastases - Bone marrow function: White Blood Cell (WBC) at least 3,000/mm3 or Absolute Neutrophil Count (ANC) = 1,500/mm3, Platelet count at least 125,000/mm3 - Liver function: aspartate aminotransferase (AST) / alanine aminotransferase (ALT) less than 3 times the upper limit of normal - Renal function: Creatinine no greater than 1.5 times the upper limit of normal - Patients who consented and signed informed consent Exclusion Criteria: - Patients with distant metastases or patients with recurrent periampullary carcinoma - Patients with active or uncontrolled infection - Patients with severe psychiatric/neurological disorders - People who are addicted to alcohol or other drugs - Patients included in other clinical studies that may affect this study - Patients unable to follow the researcher's instructions - Pregnancy - Patients with uncontrolled heart disease - Patients with moderate or more comorbidities that are judged to have an impact on quality of life or nutritional status (liver cirrhosis, chronic renal failure, heart failure, etc.) - Patients who underwent major abdominal organ surgery other than scheduled pancreaticoduodenectomy. - Patients who require combined resection of other major abdominal organs in addition to scheduled pancreaticoduodenectomy - History of allergy to local anesthetics - Local infection at the treatment site - Patients with neurological or mental health conditions - A history of spinal surgery or compression fractures at abdominal level - Patients with coagulopathy (Platelet < 125,000/mm3 or International Normalized Ratio (INR) = 1.5) or who continue to take anticoagulants or antithrombotic drugs without stopping - Others who are not suitable for research in the judgment of the clinician

Study Design


Related Conditions & MeSH terms


Intervention

Other:
ERAS perioperative management
Epidural analgesia Fluid balance Other items are the same as conventional

Locations

Country Name City State
Korea, Republic of Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine Seoul

Sponsors (1)

Lead Sponsor Collaborator
Asan Medical Center

Country where clinical trial is conducted

Korea, Republic of, 

References & Publications (6)

Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebo LM, Carli F. Enhanced Recovery After Surgery (ERAS) for gastrointestin — View Citation

Hwang DW, Kim HJ, Lee JH, Song KB, Kim MH, Lee SK, Choi KT, Jun IG, Bang JY, Kim SC. Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial. J Hepatobiliary Pancreat Sci. 2019 Aug;26(8):360-369. doi: 10 — View Citation

Kim HE, Kim YH, Song KB, Chung YS, Hwang S, Lee YJ, Park KM, Kim SC. Impact of critical pathway implementation on hospital stay and costs in patients undergoing pancreaticoduodenectomy. Korean J Hepatobiliary Pancreat Surg. 2014 Feb;18(1):14-20. doi: 10.1 — View Citation

Kuemmerli C, Tschuor C, Kasai M, Alseidi AA, Balzano G, Bouwense S, Braga M, Coolsen M, Daniel SK, Dervenis C, Falconi M, Hwang DW, Kagedan DJ, Kim SC, Lavu H, Liang T, Nussbaum D, Partelli S, Passeri MJ, Pecorelli N, Pillai SA, Pillarisetty VG, Pucci MJ, — View Citation

Lee JH, Kim DH, Koh WU. Real-time ultrasound guided thoracic epidural catheterization: a technical review. Anesth Pain Med (Seoul). 2021 Oct;16(4):322-328. doi: 10.17085/apm.21060. Epub 2021 Oct 29. — View Citation

Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, Wellge EB, Kunzler F, Besselink MG, Asbun H, Scott MJ, Dejong CHC, Vrochides D, Aloia T, Izbicki JR, Demartines N. Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery A — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Functional recovery date on postopreative 7th day Pain control is possible only with oral or patch-type analgesics without intravenous analgesic administration
Able to walk freely
Free eating is possible
There should be no evidence of infection related to surgery
No intravenous nutritional injection (total parenteral nutrition) being administered
The investigators evaluate the five items to the participant starting on the 7th day after surgery. A date that satisfies all five items is defined as functional recovery date.
Secondary Postoperative complication All complications after surgery are included. Especially, delayed gastric emptying, postpancreatectomy hemorrhage, postoperative pancreatic fistula and chyle leak will be classified by the criteria of International Study Group on Pancreatic Surgery.
The severity of all complication will be divided depends on Clavien Dindo classification (Grade from I to V, higher scores mean a better outcome).
Three months after surgery
Secondary Postoperative mortality All in-hospital mortality and 90 days mortality 90 days after surgery
Secondary Re-admission rate For any reason, all readmitted patients are included. 3 months after surgery
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