Aortic Laryngeal Rehabilitation Graft

NCT ID: NCT04650919

Last Updated: 2022-12-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

4 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-29

Study Completion Date

2026-07-28

Brief Summary

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The larynx is a cartilaginous organ of the respiratory system located in the throat, which plays an essential role in respiratory function, swallowing and sound production.

In the case of advanced tumours, the surgical option most often remains total laryngectomy, with the corollary of a major impact on quality of life, not so much because of the loss of voice, but because of the presence of a definitive tracheostoma with particularly deleterious consequences.

The majority of the work of the different teams around the world has focused on restoring phonatory function, but no technique - apart from the artificial larynx developed in the ENT department of the Hautepierre Hospital - has yet succeeded in removing the tracheotomy orifice, requiring the restoration of a common passage between the respiratory and swallowing passages. If nutrition and phonatory function can still be supplemented after such an operation (oesophageal rehabilitation, implant placed between the trachea and oesophagus), natural breathing is no longer possible. Patients are forced to wear a permanent tracheotomy opening.

There are currently only 2 ways to try to restore all the functions of the larynx after total laryngectomy: i) laryngeal transplantation, but this procedure requires maintaining immunosuppressive treatment, which is not possible in patients suffering from cancer of the larynx, which is not a vital organ, ii) artificial larynx made of biomaterials (titanium), the first cases of which were performed worldwide in the ENT department of the Strasbourg University Hospital in 2012, results published in the NEJM (API 2008-2009 HUS No. 4493- IDRCB No.: 2011-A00032-39. However, difficulties were encountered with the use of the titanium prosthesis due to the bulk and rigidity of the removable and non-removable part, which caused residual swallowing difficulties (false routes).

It is now possible, due to the development of new allograft techniques in humans for tracheal replacement (studies published on a large number of cases with several years of hindsight, cf. references), to switch to the "all biological" using an aortic graft stented with a silicone stent. We wish to use these grafts in laryngeal restoration after total laryngectomy by our team, while exploiting all the data and experience acquired (unique in the world) within the ENT department of Hautepierre Hospital. This new conceptual leap should make it possible to significantly improve the patient's quality of life and the performance previously acquired in clinical trials on the artificial larynx in its entirety (breathing, phonation) or partially (swallowing).

The investigators thus propose to evaluate this new artificial larynx in aortic allograft, the objective of which is to supplement the respiratory, swallowing and phonation functions in patients laryngectomized for carcinological causes.

Detailed Description

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Conditions

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Laryngeal Cancer Total Laryngectomy

Keywords

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laryngectomy

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental arm

Group Type EXPERIMENTAL

Total laryngectomy and reconstruction by stented aortic allograft (using human tissue and device).

Intervention Type PROCEDURE

The procedure consists of 2 operating times:

* Surgery S1 (1st surgical procedure): total laryngectomy and placement of the stented aortic graft (human tissue + device: NOVATECH GSS TM (trademark) TD), under tracheotomy cover.
* Surgery S2 (2nd surgical procedure) (between S1 +24 weeks and S1 +36 weeks) : opening of the proximal part of the graft by endoscopic way with maintenance of the tracheotomy orifice to ensure patient safety.

Interventions

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Total laryngectomy and reconstruction by stented aortic allograft (using human tissue and device).

The procedure consists of 2 operating times:

* Surgery S1 (1st surgical procedure): total laryngectomy and placement of the stented aortic graft (human tissue + device: NOVATECH GSS TM (trademark) TD), under tracheotomy cover.
* Surgery S2 (2nd surgical procedure) (between S1 +24 weeks and S1 +36 weeks) : opening of the proximal part of the graft by endoscopic way with maintenance of the tracheotomy orifice to ensure patient safety.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient with carcinomatous pathology of the upper airways requiring total laryngectomy
* Patient affiliated to a social health insurance scheme (beneficiary or beneficiary's successor)
* Patient speaks and reads French, understands the objectives and risks of the research and is able to provide dated and signed informed consent.
* Patient having been informed of the results of the prior medical examination
* For a woman with the ability to procreate: negative blood pregnancy test (verified during preoperative blood work) and effective contraception throughout the study.

Exclusion Criteria

* Patient with a contraindication to general anaesthesia and/or iodinated contrast agents
* Breastfeeding woman
* Patient with a WHO performance index of grade strictly greater than 2 at the inclusion visit
* Patient with subglottic or basi-lingual tumour extension greater than 1 cm (by endoscopic control and CT scan)
* Patient having undergone cervico-facial radiotherapy prior to surgical management
* Patient suffering from severe coagulation disorders (checked during the blood test performed as part of the standard care to make the diagnosis of cancer)
* Patient with a history of allergy to DMSO, DHEA, clindamycin, gentamicin, vancomycin used for graft treatment and preservation
* Inability to give informed information about the patient (patient in emergency situations, difficulties in understanding the patient)
* Patient in exclusion period (determined by a previous or ongoing study)
* Patient under safeguard of justice
* Patient under guardianship,curatorship, family guardianship
* Any situation considered by the operating physician as falling under a non-inclusion criterion
* Patient suffering from a decompensated psychiatric pathology or at risk of decompensation, which may interfere with the follow-up modalities in the research setting.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Etablissement Français du Sang

OTHER

Sponsor Role collaborator

University Hospital, Strasbourg, France

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Christian DEBRY, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Hôpitaux Universitaires de Strasbourg

Locations

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ENT department-Hôpitaux Universitaires de Strasbourg

Strasbourg, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Christian DEBRY, MD PhD

Role: CONTACT

Phone: +33 (0)3 88 12 76 44

Email: [email protected]

Facility Contacts

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Christian DEBRY, MD PhD

Role: primary

Other Identifiers

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7649

Identifier Type: -

Identifier Source: org_study_id