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Fast-track Perioperative Program for Laparoscopic Colorectal Surgery

29. april 2013 opdateret af: Simon S. M. Ng, Chinese University of Hong Kong

The Impact of Fast-track Perioperative Program on the Clinical and Immunological Outcomes After Laparoscopic Colorectal Surgery in Hong Kong Chinese Patients: A Prospective Randomized Trial

Background:

Laparoscopic colorectal surgery has been shown by randomized trials to be associated with better short-term clinical outcomes when compared with open surgery. However, in a traditional perioperative care setting, the reduction in hospital stay following laparoscopic surgery in these trials was modest. Fast-track perioperative programs have been introduced in the West to optimize perioperative factors to reduce the physiological/psychological stress of open colorectal surgery. However, few studies have evaluated the impact of fast-track programs on the outcomes after laparoscopic colorectal surgery.

Objective:

To compare the clinical and immunological outcomes of Hong Kong Chinese patients undergoing laparoscopic surgery for colorectal cancer with a "traditional" vs. a "fast-track" perioperative program.

Design:

Prospective randomized trial.

Subjects:

One hundred and twenty-eight consecutive patients undergoing elective laparoscopic resection of non-metastatic colonic and upper rectal cancer will be recruited.

Interventions:

Patients will be randomized to a "traditional" or a "fast-track" perioperative program.

Outcome measures:

Primary outcome: total postoperative hospital stay, including hospital stay of patients who are readmitted within 30 days after surgery. Secondary outcomes: immunological parameters (including systemic cytokine response and cell-mediated immune function), morbidity and mortality, quality of life, and medical costs.

Studieoversigt

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

128

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

      • Hong Kong, Kina
        • Prince of Wales Hospital, the Chinese University of Hong Kong

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion criteria:

  • Consecutive patients undergoing elective laparoscopic resection of colonic and upper rectal cancer,
  • Age of patients between 18 and 75 years
  • Patients with American Society of Anesthesiologists grading I-II
  • Patients with no severe physical disability
  • Patients who require no assistance with the activities of daily living
  • Informed consent available

Exclusion criteria:

  • Patients undergoing laparoscopic low anterior resection with total mesorectal excision, abdominoperineal resection, or total/proctocolectomy
  • Patients with planned stoma creation
  • Patients undergoing emergency surgery
  • Patients with known metastatic disease
  • Patients with previous history of abdominal surgery
  • Patients with known immunological dysfunction
  • Patients who are taking steroids or immunosuppressive agents
  • Patients with chronic pain syndrome

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Fast-track perioperative program
Preoperative counseling, no preoperative fasting, short-acting anesthetics, continuous infiltration of wound with local anesthetic agent, non-opioid pain management, the use of chewing gum, and early postoperative feeding and mobilization
Aktiv komparator: Traditional perioperative program
Preoperative fasting, standard anesthetic management with no intraoperative fluid restriction, opioid pain management, no chewing gum, feeding/mobilization according to attending surgeon

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Duration of hospital stay
Tidsramme: Up to 1 month
Total postoperative hospital stay, including hospital stay of patients who are readmitted within 30 days after surgery.
Up to 1 month

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Direkte/indirekte medicinske omkostninger og økonomiske omkostninger uden for hospitalet
Tidsramme: Op til 1 måned
Op til 1 måned
Genindlæggelsesrate
Tidsramme: Op til 1 måned
Op til 1 måned
Pain scores
Tidsramme: Up to 1 week
Pain scores on visual analogue scale (from 0 which implies no pain at all, to 100 which implies the worst pain imaginable)
Up to 1 week
Morbidity and mortality
Tidsramme: Up to 1 month
Up to 1 month
Quality of life
Tidsramme: Up to 1 month
Measured by SF-36, EORTC QLQ-C30 and QLQ-CR38 questionnaires
Up to 1 month
Systemic cytokine responses
Tidsramme: Up to 1 week
Blood levels of IL-1β, IL-6, and C-reactive protein
Up to 1 week
Lymphocyte subsets
Tidsramme: Up to 1 week
Using flow cytometer to determine lymphocyte subsets and NK cell counts (cells/uL)
Up to 1 week

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. november 2010

Primær færdiggørelse (Faktiske)

1. marts 2013

Studieafslutning (Faktiske)

1. marts 2013

Datoer for studieregistrering

Først indsendt

20. april 2011

Først indsendt, der opfyldte QC-kriterier

22. april 2011

Først opslået (Skøn)

25. april 2011

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

30. april 2013

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. april 2013

Sidst verificeret

1. april 2013

Mere information

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Kolorektal cancer

Kliniske forsøg med Fast-track perioperative program

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