- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01865838
A Study Into the Effect of Seprafilm in Open Total Thyroidectomy
A Study Into the Effect of Seprafilm on Post Operative Adhesions After Open Total Thyroidectomy.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Thyroid surgery not only constitutes one of the main pillars in the treatment of thyroid cancers, but is also employed in the management of symptomatic goitres. Occasionally, it is mandated in patients with thyrotoxicosis refractory to medical therapy. While thyroid surgery can be performed with low risks such that patients rarely have to stay beyond three days in hospital, the track record of thyroid surgery is somewhat blemished by the unfortunate side effects associated with the neck scarring after thyroid surgery. Not uncommonly, patients experience discomfort in the neck region after thyroid surgery; in the extreme of cases, patients may even complain of a lifelong pulling sensation in the neck area during eating.
The anti-adhesive properties of Seprafilm are well established in animal studies and affirmed by clinical observations in abdominal surgeries that utilize this material. Thus, Seprafilm is routinely used in instances when a surgeon foresees a need to perform abdominal surgery on the same patient in future, or during the fashioning of a temporary stoma. The safety profile of Seprafilm in thyroidectomy has also been shown by a recent study conducted by a group of clinicians in Seoul.
We postulate that the application of Seprafilm to the surgical wound towards the end of a thyroidectomy significantly reduces internal adhesion formation in the neck region. By achieving this objective, we hope to improve patients' satisfaction with thyroid surgery in terms of ease of swallowing after surgery.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Singapore, Singapore, 169608
- Singapore General Hospital
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Singapore, Singapore, 169610
- National Cancer Centre Singapore
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 21-75
- Histological confirmation of differentiated thyroid cancer requiring surgery, symptomatic goiters, thyroid nodules requiring histological analysis, or thyrotoxicosis poorly controlled by medication.
- Undergoing total thyroidectomy
Exclusion Criteria:
- Previous neck surgery
- Previous neck radiotherapy
- Patients with a known history of keloids
- Patients with a known history of motility disorders in the upper gastrointestinal tract and preexisting swallowing difficulty.
- Patients with metastatic disease; patients with disease that would require postop radiation therapy, radionuclide iodine therapy and any adjuvant therapies.
- Patients with advanced disease that would require radical or modified neck dissection
- Patients with lobe larger than 10 cm, or nodule larger than 8 cm which require extensive dissection that may confound the study
- Patients with connective tissue diseases and chronic diseases on long-term medications that may interfere with wound healings such as steroids
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Seprafilm (Sanofi, USA)
Patients in this arm received Seprafilm during surgery.
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Studies have unequivocally shown that Seprafilm is effective in reducing internal adhesion formation after abdominal surgery.
In a large scaled randomized controlled trial involving about 1700 patients, Fazio et al. found that the use or Seprafilm reduces the risk of small bowel intestinal obstruction which required operative intervention.
The safety profile of Seprafilm has also been nicely demonstrated in a randomized controlled trial by Beck et al. in this study, the authors concluded that within the context of abdomino-pelvic surgery, Seprafilm does not increase the incidence of abdominal/pelvic abscesses in patients after abdomino-pelvic surgery; if anything, the anti-adhesive properties of Seprafilm are such that the authors noted an increased risk of anastomotic complications in patients whose bowel anastomoses were in close contact with Seprafilm.
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No Intervention: Control
Patients in this arm does NOT receive Seprafilm during surgery.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Cricoid elevation
Time Frame: 1 to 14 days before the surgery, postop day 14 and 3 months postop
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Trial candidates are to undergo videofluoroscopy to assess their swallowing and cricoid elevation is measured using ImageJ.
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1 to 14 days before the surgery, postop day 14 and 3 months postop
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hyoid elevation
Time Frame: 1 to 14 days before the surgery, postop day 14 and 3 months postop
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Trial candidates are to undergo videofluoroscopy to assess their swallowing and hyoid elevation is measured using ImageJ.
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1 to 14 days before the surgery, postop day 14 and 3 months postop
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Crico-hyoid distance
Time Frame: 1 to 14 days before the surgery, postop day 14 and 3 months postop
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Trial candidates are to undergo videofluoroscopy to assess their swallowing and hyoid elevation is measured using ImageJ.
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1 to 14 days before the surgery, postop day 14 and 3 months postop
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Videotaping measurement
Time Frame: 1 to 14 days before the surgery, postop day 14 and 3 months postop
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Trial candidates are to undergo videotaping of their surgical incision site during swallowing. Maximal displacement of the incision site will be measured and recorded using ImageJ.
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1 to 14 days before the surgery, postop day 14 and 3 months postop
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Swallowing Quality of Life questionaire
Time Frame: 1 to 14 days before the surgery, postop day 14 and 3 months postop
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Trial candidates will be interviewed regarding their swallowing using the Sydney Swallowing questionnaire. Patients will be interviewed three times.
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1 to 14 days before the surgery, postop day 14 and 3 months postop
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration of surgery
Time Frame: During surgery
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-Knife-to-skin time to closure.
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During surgery
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Drainage
Time Frame: Day 1 to Day 3 after the surgery
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-Surgical drain will be placed for patients at surgeons' discretion.
Drain amount will be recorded.
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Day 1 to Day 3 after the surgery
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Khoon H Tan, MBBS, PhD, National Cancer Centre, Singapore
Publications and helpful links
General Publications
- Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG; Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003 Oct;46(10):1310-9. doi: 10.1007/s10350-004-6739-2.
- Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Gohl J. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006 Jan;49(1):1-11. doi: 10.1007/s10350-005-0268-5.
- Park WS, Chung YS, Lee KE, Kim HY, Choe JH, Koh SH, Youn YK. Anti-adhesive effect and safety of sodium hyaluronate and sodium carboxymethyl cellulose solution in thyroid surgery. Asian J Surg. 2010 Jan;33(1):25-30. doi: 10.1016/S1015-9584(10)60005-X.
- Metwally M, Cheong Y, Li TC. A review of techniques for adhesion prevention after gynaecological surgery. Curr Opin Obstet Gynecol. 2008 Aug;20(4):345-52. doi: 10.1097/GCO.0b013e3283073a6c.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Seprafilm in Thyroidectomy
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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