ULTRA-LAP Trial: Laparoscopic Debulking Surgery (LDS) in Advanced Ovarian Cancer (ULTRA-LAP)

May 8, 2023 updated by: Roberto Tozzi, Azienda Ospedaliera di Padova

ULTRA-LAP Trial: Laparoscopic Debulking Surgery (LDS) in Advanced Ovarian Cancer: a Feasibility Prospective Study

ULTRA-LAP is a prospective study is to investigate the safety, efficacy and feasibility of laparoscopic debulking surgery (LDS) for the treatment of patients with advanced ovarian cancer.

The outcomes to measure are:

  • Safety: the rate of patients experiencing intra- and post-operative early and late morbidities (within the hospitalization and up to 60 days from surgery)
  • Efficacy: the rate of patients in which the surgical target set pre-operatively (complete resection) is achieved by laparoscopy.
  • Feasibility: the rate of patients who have their procedure completed by laparoscopy

Patients will undergo laparoscopic debulking surgery (LDS) if the surgical target can be met. If it cannot be achieved by laparoscopy the surgeon will convert to laparotomy.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The investigators intend to perform a prospective feasibility study on patients with primary diagnosis of advanced ovarian cancer (stage II to IV according to FIGO classification) who are referred to the tertiary cancer centre of the study. The latter is the Department of Gynecology and Obstetrics - Division of Women's and Children's Health - University of Padova - Italy. The statistical sample size calculation identified a minimum of 62 patients. The anticipated enrollment period will be about 4 years.

To confirm the ultimate eligibility to surgery and recruitment in the study, all patients undergo an exploratory laparoscopy (EXL).

The ideal surgical target is complete resection (CR) of all visible disease. Patients who are deemed not amenable to a CR at EXL will start neo-adjuvant chemotherapy. They will be reconsidered for the ULTRA-LAP study at time of interval surgery after 3 cycles of chemotherapy. Criteria for eligibility after neo-adjuvant chemotherapy are the same as per up-front surgery.

All patients recruited in the ULTRA-LAP trial will be discussed at Gynaecologic Oncology Multidisciplinary team (MDT) meeting, where imaging is reviewed and management is agreed. Following MDT decision:

  • A Gynaecologic Oncologist will discuss the standard management and the ULTRA-LAP trial at time of out-patient clinic
  • The ULTRA-LAP leaflet and consent form will be provided to the patient together with an accurate explanation of the study
  • If the patient accepts to enter the study, a study registration form will be filled
  • Participation in the study will be confirmed and the forms signed at time of pre-operative assessment and again confirmed at time of in-patient admission ULTRA-LAP trail will include all surgical procedures necessary to accomplish a complete resection (CR) of disease. The most common procedures necessary to obtain a CR are defined by The European Society of Gynaecological Oncology (ESGO), Society of Gynecologic Oncology (SGO) and the The National Institute for Health and Care Excellence (NICE) guidelines. All procedures will be performed by an expert Gynaecologic Oncologist with proven experience and high skills levels in oncological surgery. Once the surgeon realizes that a CR could not be achieved by laparoscopy, but prove to be feasible by laparotomy, the surgery is immediately converted to laparotomy.

Subsequent follow-up:

  1. During Recovery:

    - The patients are going to be monitored daily and any relevant complications will be registered, graded (according to Clavien-Dindo classification) and treated.

  2. Post recovery:

    • 1 st follow-up visit: At time of hospital's discharge an examination will be performed and, if necessary, further exams will be prescribed as appropriate.
    • 2 nd follow-up visit: following discharge, the next appointment is in the outpatient clinic roughly 15-20 days from the surgery.
    • 3 rd and last visit: at 30 days from the surgery a further appointment will be carried.

At each follow-up appointment the following will be registered:

  • Occurrence of complications
  • Physical examination
  • Changes in normal quality of life.

Achievement of a CR will be determined at time of surgery and confirmed by a pre-chemotherapy CT scan. Should discrepancy arise, CT scan will be reviewed at MDT.

All patients will be closely monitored with a rigorous follow-up program every 90 days for the first two years and then every 120 days for the subsequent 2 years. In addition, all patient could contact the department if any unexpected complications happens between follow-up time.

Study Type

Interventional

Enrollment (Anticipated)

62

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Italy
    • Padova, Veneto
      • Padova, Padova, Veneto, Italy, 35128
        • Recruiting
        • Azienda Ospedaliera Universitaria di Padova,
        • Contact:
        • Contact:
        • Sub-Investigator:
          • Carlo Saccardi, Professor
        • Sub-Investigator:
          • Marco Noventa, MD
        • Sub-Investigator:
          • Matteo Marchetti, MD

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients with advanced epithelial ovarian cancer (II-IV Stage FIGO) candidates to PDS (primary debulking surgery) or IDS (interval debulking surgery: neoadjuvant chemotherapy followed by IDS).
  • Participant is willing and able to give informed consent for participation in the study.
  • Female aged 18 years or above.
  • Primary diagnosis of advanced epithelial ovarian cancer (tubal and peritoneal cancer included).

Exclusion Criteria:

  • Comorbidities non-allowing for radical surgery
  • Poor Performance Status (Karnofsky Index < 70)
  • Concomitant or past history of malignancy, regardless of treatment status
  • Recent or past story of pancreatitis or hepatitis
  • Recent or past story of pleural effusion or lung injuries or respiratory failure
  • Cardiac major pathologies

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: Non-Randomized
  • Interventional Model: Factorial Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Laparoscopic debulking surgery - LDS
Primary debulking surgery or Interval debulking surgery performed by laparoscopy (P-LDS and I-LDS)
Procedure: Laparoscopic Debulking Surgery in advanced ovarian cancer
Laparoscopic debulking will be conducted until the surgical target is achieved or the operation is converted to laparotomy.
Active Comparator: Debulking surgery - DS
Primary debulking surgery or Interval debulking surgery performed by/converted to laparotomy (PDS and IDS)
Procedure: Standard laparotomic Debulking Surgery in advanced ovarian cancer
Debulking by laparotomy in patients when debulking could not be accomplished by laparoscopy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety: rate of complications/morbidities
Time Frame: 60 days
Safety will be measured as the rate of patients experiencing intra- and post-operative early and late morbidities (within and after the hospitalization up to 60 days from surgery) and it will be compared to the morbidity rate of patients having similar surgery by laparotomy. Complications are going to be graded according to Clavien-Dindo classification.
60 days
Efficacy: rate of complete resection (CR) in group 1
Time Frame: 60 days
Efficacy will be measured as the rate of patients in which the surgical target set pre-operatively is achieved by laparoscopy.
60 days
Feasibility: rate of procedures completed by laparoscopy
Time Frame: 60 days
Feasibility will be measured as the rate of patients who have their procedure completed by laparoscopy.
60 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression Free Survival (PFS).
Time Frame: 5 years
the time interval from the surgical treatment to the date of the documented first recurrence of disease, by CA 125 (Carbohydrate Antigen 125) and/or CT scan.
5 years
Overall Survival (OS).
Time Frame: 5 years
time between surgery and death.
5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Azienda Ospedaliera di Padova

Collaborators

University of Padova

Investigators

  • Principal Investigator: Roberto Tozzi, Professor, Azienda Ospedale Università di Padova

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Actual)

January 2, 2022

Primary Completion (Anticipated)

December 31, 2026

Study Completion (Anticipated)

December 31, 2027

Study Registration Dates

First Submitted

March 10, 2023

First Submitted That Met QC Criteria

May 8, 2023

First Posted (Actual)

May 17, 2023

Study Record Updates

Last Update Posted (Actual)

May 17, 2023

Last Update Submitted That Met QC Criteria

May 8, 2023

Last Verified

May 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 5497/AO/22
  • AOP2674 (Other Identifier: University of Padova)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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