- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04938973
NIF-Guided RAMIE Using ICG Versus OTE Feasibility RCT (RAMIE vs OTE)
Near-Infrared Fluorescence-Guided Robotic-Assisted Minimally Invasive Esophagectomy Using Indocyanine Green Dye Versus Open Transthoracic Esophagectomy: A Randomized Controlled Feasibility Trial
Study Overview
Status
Conditions
Detailed Description
In Canada, the incidence of esophageal cancer has been increasing over time. The treatment of patients with cancer of the esophagus is multi-modal, with surgery being the cornerstone of most treatment regimens. Operative treatment is usually performed through Open Transthoracic Esophagectomy (OTE), a highly morbid procedure that is associated with a complication rate of 60-80%, and a recovery period of many months. This standard is being challenged by a growing body of evidence demonstrating that a minimally invasive approach can reduce post-operative morbidity and improve quality-of-life, while still offering an adequate oncological outcome. The minimally invasive alternative to OTE is Minimally Invasive Esophagectomy (MIE). Although MIE has been shown to reduce the morbidity associated with esophagectomy, it has not been widely adopted. This failure of adoption is due to the high complexity of MIE; it is an exceedingly difficult operation, is associated with a very steep learning curve, and can take 8-10 hours to complete. As a result, less than 10% of esophageal cancer programs in Canada have adopted MIE, and there remains a need for a minimally invasive alternative to OTE. Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) has recently emerged as a minimally invasive alternative to OTE. RAMIE utilizes the DaVinci Xi robotic surgical platform which offers superior dexterity, 3D-vision, 7-degrees of freedom for range of motion, and near-infrared imaging for detection of blood vessels. As a result, RAMIE has succeeded where MIE has failed, and has been widely taken up in Europe and the United States.
To date, near-infrared fluorescence (NIF)-guided RAMIE using indocyanine green (ICG) dye has not been performed in Canada, and there has been no randomized trial that has compared NIF-guided RAMIE using ICG dye to OTE. In this study, we propose to build the infrastructure for introducing NIF-guided RAMIE using ICG dye to Canada, while laying the foundations for a future randomized controlled trial (RCT) which will compare it to OTE. This study is a Phase I, single center, prospective feasibility randomized controlled trial with two phases: Phase A: Learning Curve of NIF-guided RAMIE using ICG dye; and Phase B: A Randomized Controlled Feasibility Trial. In Phase A, 40 patients will be enrolled, and they will all undergo NIF-guided RAMIE using ICG dye. Evidence shows that a surgeon experienced in MIE requires experience of 40 cases to gain proficiency of RAMIE. In Phase B, 54 patients will be enrolled, and they will be randomized to either NIF-guided RAMIE using ICG dye, or OTE.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Yogita S. Patel
- Phone Number: 35096 905-522-1155
- Email: patelys@mcmaster.ca
Study Contact Backup
- Name: Jacob A. Alaichi
- Phone Number: 35169 905-522-1155
- Email: alaichij@mcmaster.ca
Study Locations
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Ontario
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Hamilton, Ontario, Canada, L8N4A6
- Recruiting
- St. Joseph's Healthcare Hamilton
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Contact:
- Yogita S. Patel
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18 or older
- Clinical Stage I, II, or III esophageal cancer, who are candidates for surgery after discussion in multidisciplinary tumor board.
- Candidates for minimally invasive surgery as determined by the operating surgeon.
Exclusion Criteria:
- Hypersensitivity or allergy to ICG, sodium iodide, or iodine
- Women who are currently pregnant or are breastfeeding; or women of childbearing potential who are not currently taking adequate birth control
- Clinical Stage IV esophageal cancer.
- Not a candidate for minimally invasive surgery as determined by the operating surgeon.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: NIF-Guided RAMIE using ICG Dye (Experimental Arm)
The patient will undergo NIF-guided RAMIE using ICG dye using the standard Ivor-Lewis approach.
This will be a two-stage operation involving a first stage through a 5-port robotic approach through the abdomen to achieve a proximal gastrectomy and D2 nodal dissection.
A feeding jejunostomy would not be inserted, as per the enhanced recovery pathway for esophagectomy.
In addition, the vascularization of the conduit can be confirmed using the near-infrared camera of the robot with the ICG dye.
The second stage of the operation will involve a 4-port robotic approach through the right chest to achieve thoracic nodal dissection, esophagectomy, and a hand-sewn anastomosis between the residual esophagus and the gastric conduit at the level of the azygous vein.
During this second stage of the operation, NIF with ICG dye will be used to visualize the vascular supply of the gastric conduit, and assess the gastric conduit for any perfusions to potentially reduce anastomotic leaks.
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Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) will be performed using the Da Vinci Robotic Surgical Platform.
Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) will be performed using the Da Vinci Robotic Surgical Platform.
|
Active Comparator: Open Transthoracic Esophagectomy (OTE)
The patient will undergo OTE using the standard Ivor-Lewis approach.
This is a two-stage operation involving a first stage through laparotomy, proximal gastrectomy, D2 nodal dissection, and insertion of feeding jejunostomy.
The second stage of the operation will involve a right thoracotomy, thoracic nodal dissection, esophagectomy, and a stapled anastomosis between the residual esophagus and the gastric conduit at the level of the azygous vein.
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Open Transthoracic Esophagectomy (OTE) is the current standard of care.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The feasibility of a large-scale RCT, as measured by the number of patients willing to participate in the study.
Time Frame: 3-Weeks Postoperative
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A recruitment rate ≥70%, whereby participants partake in the study until first post-operative follow-up, would be considered acceptable.
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3-Weeks Postoperative
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety of the Operation, based on rates of perioperative complications
Time Frame: 12-Weeks Postoperative
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The safety of the operation based on rates of perioperative complications within 90-days of surgery, as defined by the Ottawa Thoracic Morbidity and Mortality Classification System (TMNM).
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12-Weeks Postoperative
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Patient-Reported Health-Related Quality of Life - Pain Level
Time Frame: Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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The Stanford Pain Scale will be administered to patients to assess pain (0 = no pain, 10 = worst pain)
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Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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Patient-Reported Health-Related Quality of Life - Quality of Life
Time Frame: Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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EQ-5D-5L will be administered to patients to assess pain and quality of life.
5 items + overall health rating (0-100; 0 worst health imaginable, 100 best health imaginable)
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Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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Patient-Reported Health-Related Quality of Life - Reintegration into Normal Living
Time Frame: Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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Reintegration to Normal Living Index will be administered to patients to assess quality of life.
11 items, each item scored from 1-10 (1 = no reintegration, 10 = complete reintegration)
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Baseline, Postoperative Day 1, 3-Weeks Postoperative, 12-Weeks Postoperative
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Conversion from RAMIE to OTE
Time Frame: During Surgery
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Rate of conversions from RAMIE to OTE
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During Surgery
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Length of Stay (LOS)
Time Frame: From Date of Admission to Date of Discharge, assessed up to 12-Weeks Postoperative
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Length of hospital stay will be measured between the date of admission and date of discharge.
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From Date of Admission to Date of Discharge, assessed up to 12-Weeks Postoperative
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Length of Operation
Time Frame: During Surgery
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Operative time will be measured by collecting the procedure start and procedure end time
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During Surgery
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Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- SJHH_RAMIE_vs_OTE_Feasibility
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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