- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02634385
Zero Ischemia Laparoscopic Partial Nephrectomy (ZILPAREMZ)
July 26, 2016 updated by: Anil Kapoor, St. Joseph's Healthcare Hamilton
Zero Ischemia Laparoscopic Partial Nephrectomy in Combination With Superselective Renal Artery Embolization for Small Renal Masses: A Feasibility Trial
Laparoscopic partial nephrectomy (LPN) is often reserved for patients with a small peripheral tumour, in the hands of an experienced surgeon since it demands a high degree of endoscopic skill.
Renal vessel clamp for vascular control is a required step during standard LPN.
However, this creates a time limiting step for the surgeon and induces renal injury via warm ischemia and reperfusion injury.
This novel approach can substantially reduce renal injury during LPN via superselective embolization of level II renal arteries pre-operatively.
This technique facilitates the performance of a clamp-less, zero-ischemia LPN, significantly simplifying the procedure by remove time thresholds within which to perform tumor excision.
The preliminary results are promising; however, there is a need for further corroboration of their results, in addition to a randomized controlled trial comparing this modified, zero ischemia technique with standard LPN.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
The potential utility of a zero ischemia, laparoscopic, partial nephrectomy portends significant implications for both the surgeon and patient.
Firstly, the technical difficulty of a partial nephrectomy will be reduced to a more achievable level owing mainly to the removal of a time limit on surgical resection.
With the blood flow halted to downstream tissue containing the renal neoplasm from preoperative embolization, resection can be made to the tumor without clamping of the main renal arteries.
This minimizes the ischemic time to non-neoplastic renal tissue, allowing for a renal protective effect.
Without the need for clamping, the overall surgical operative time is drastically reduced.
With excision made at the ischemic tissue, intra-operative bleeding and ease can be achieved.
More surgeons can ultimately attempt at LPN by removing the single most limiting surgical factor, warm ischemic time.
Study Type
Interventional
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Ontario
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Hamilton, Ontario, Canada, L8N4A6
- St. Joseph's Healthcare Hamilton - McMaster Institute of Urology
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- T1a renal cell carcinomas diagnosed by ultrasonography (US), computed tomography (CT) or fine needle aspiration
- tumor size <4cm in diameter
- predominant exophytic growth
- intraparenchymal depth no greater than 1.5cm, with a minimum distance of 5mm from the urinary collecting system
Exclusion Criteria:
- predominant endophytic nature (depth </= 1.5 cm)
- nearness (<0.5cm) of the tumor to the urinary collecting system
- multiple ipsilateral lesions
- pregnancy
- allergy to intravenous contrast dye
- absolute contraindications to surgical intervention
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Small Renal Mass
Patient's with a small renal mass will be undergoing embolization prior to laparoscopic partial nephrectomy.
|
Patients will be receiving embolization prior to planned partial nephrectomy.
Patients will be undergoing planned partial nephrectomy post embolization.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Extirpative time
Time Frame: Duration of Surgical Procedure
|
From initial renal tissue breach until completion of bolster placement.
Calculated in minutes.
|
Duration of Surgical Procedure
|
Warm ischemia time
Time Frame: Duration of Surgical Procedure
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From renal vessel clamping to unclamping during nephrectomy (only if clamping has occurred).
Calculated in minutes.
|
Duration of Surgical Procedure
|
Mean estimated blood loss (measured in ml)
Time Frame: Duration of Surgical Procedure
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From the start of procedure (Nephrectomy), until the end of the procedure.
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Duration of Surgical Procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean hospital stay
Time Frame: 2-10 Days
|
Date admitted for procedure until date of discharge.
Measure in calendar days.
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2-10 Days
|
Blood transfusions
Time Frame: From date of pre-op up to 6 months post-op
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Prior to Embolization procedure and pre and post-nephrectomy.
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From date of pre-op up to 6 months post-op
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Conversion to other type of surgery (i.e. Radical Nephrectomy)
Time Frame: Duration of Surgical Procedure
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Minutes from the start of procedure (Nephrectomy).
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Duration of Surgical Procedure
|
Identification of other complications (i.e. readmission, arteriovenous malformations)
Time Frame: Up to 24 months post-operatively.
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Complications will be monitored after patient is discharged up until two years post-operatively.
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Up to 24 months post-operatively.
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Overall survival rates
Time Frame: Up to 24 months post-operatively.
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Follow-up will be monitored.
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Up to 24 months post-operatively.
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Pathological Results (% of negative margins and benign versus malignant tumours).
Time Frame: 7 to 14 days post nephrectomy.
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Pathology results are usually not released until 7-14 days post nephrectomy.
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7 to 14 days post nephrectomy.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
November 1, 2015
Primary Completion (Anticipated)
April 1, 2016
Study Completion (Anticipated)
June 1, 2016
Study Registration Dates
First Submitted
October 10, 2014
First Submitted That Met QC Criteria
December 15, 2015
First Posted (Estimate)
December 18, 2015
Study Record Updates
Last Update Posted (Estimate)
July 27, 2016
Last Update Submitted That Met QC Criteria
July 26, 2016
Last Verified
July 1, 2016
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ZILPAREMBZ14
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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