SURGIcal COmplication and MIcrobiome ChangeS in Colorectal Surgery

NCT ID: NCT05779254

Last Updated: 2023-03-22

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

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-02-01

Study Completion Date

2026-01-31

Brief Summary

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The microbiome, the collection of microorganisms that live in our gut, plays an important role in maintaining our health, proper nutrient absorption, nutrient turnover and immunity. After birth, a symbiotic relationship develops with the strains of bacteria that colonise our gut, and the presence and proportion of bacteria is individualised and highly variable.

A healthy bacterial flora is essential for the cells of the intestinal mucosa. Glycoproteins in the cell surface mucus coat are important nutrients for bacteria, while some bacterial strains supply mucosal cells with nutrient molecules (e.g. short-chain fatty acids) that are their essential energy source.

An abnormal change in the proportion of bacterial strains that make up the microbiome, dysbacteriosis, in which pathogenic bacteria proliferate at the expense of members of the normal flora, can cause a number of pathologies. Nutrient supply to the cells of the mucosa is reduced, making them more vulnerable and leading to various pathological conditions.

The microbiome and the essential nutrients they produce have also been found to play an important role in wound healing. A decrease in the diversity of the microbiome, an increase in the relative number of pathogenic bacteria and a decrease in the proportion of 'beneficial' bacteria increases the risk of surgical complications of infection and suture failure.

Detailed Description

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A number of risk factors have been identified that increase or decrease the risk of anastomotic leak. The risk of anastomotic failure is increased by anastomosis (lower third) close to the anus, tumour size greater than 5cm in colorectal carcinoma, surgical complications, smoking, diabetes, male gender, overweight, malnutrition (protein deficiency), heart disease requiring anticoagulation, time to surgery, American Society of Anaesthesiologist score, neoadjuvant treatment, corticosteroid use. The risk of suture failure is reduced by mechanical lining, intravenous and oral non-absorbable antibiotics. The microbiome also appears to have an impact on suture failure: lower diversity of bacteria in intraoperative specimens and an increase in the number of mucin-degrading Bacteroidaceae or Lachnospiraceae strains may be associated with higher anastomotic failure.

Conditions

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Anastomotic Leak Microbial Colonization

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Oral Antibiotic Prophylaxis +

At the Uzsoki Hospital and the Department of Surgery at the University of Debrecen, patients receive preoperative neomycin- metronidazole oral antibiotic prophylaxis in addition to mechanical bowel preparation.

Neomycin Sulfate

Intervention Type DRUG

Postoperative day-1 Oral Antibiotic Prophylaxis + patients get po. 3x1000mg Neomycin sulfate and 3x500 mg Metronidazole

Oral Antibiotic Prophylaxis -

Patients admitted to the Csolnoky Ferenc Hospital in Veszprém will receive preoperative mechanical bowel preparation and no oral antibiotic prophylaxis.

No interventions assigned to this group

Interventions

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Neomycin Sulfate

Postoperative day-1 Oral Antibiotic Prophylaxis + patients get po. 3x1000mg Neomycin sulfate and 3x500 mg Metronidazole

Intervention Type DRUG

Other Intervention Names

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Metronidazole

Eligibility Criteria

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Inclusion Criteria

* Circular stapled anastomosis
* Planned surgery with colo-colic anastomosis
* No passage disorder, as it is confirmed at the first medical examination
* Not allergic to antibiotics
* Can receive a bowel preparation
* No proximal excluded intestine, i.e., the bowel preparation may be successful (ileostomy)

Exclusion Criteria

* treated with antibiotics within 2 weeks before randomisation
* allergic to any of the medicines used
* under 18 years of age
* have suffered from abdominal sepsis within 6 months prior to recruitment
* pregnancy or breastfeeding
* been treated with steroids
* any form of chronic immunosuppression
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Debrecen

OTHER

Sponsor Role collaborator

Csolnoky Ferenc Hospital

UNKNOWN

Sponsor Role collaborator

Uzsoki Hospital

OTHER

Sponsor Role lead

Responsible Party

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Dr. Papp Géza

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter Bay, Prof.

Role: STUDY_DIRECTOR

University of Debrecen

Locations

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Uzsoki Hospital

Budapest, , Hungary

Site Status RECRUITING

University of Debrecen

Debrecen, , Hungary

Site Status NOT_YET_RECRUITING

Csolnoky Ferenc Kórház

Veszprém, , Hungary

Site Status NOT_YET_RECRUITING

Countries

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Hungary

Central Contacts

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Géza Papp, MD

Role: CONTACT

+36302121102

Attila Bursics, MD PhD

Role: CONTACT

Facility Contacts

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Géza Papp, MD

Role: primary

Attila Bursics, MD PhD

Role: backup

Péter Kolozsi, MD

Role: primary

Dezső Tóth, Prof.

Role: backup

Tibor Nagy, MD

Role: primary

Elemér Mohos, MD PhD

Role: backup

References

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Hajjar R, Santos MM, Dagbert F, Richard CS. Current evidence on the relation between gut microbiota and intestinal anastomotic leak in colorectal surgery. Am J Surg. 2019 Nov;218(5):1000-1007. doi: 10.1016/j.amjsurg.2019.07.001. Epub 2019 Jul 11.

Reference Type BACKGROUND
PMID: 31320106 (View on PubMed)

van Praagh JB, de Goffau MC, Bakker IS, van Goor H, Harmsen HJM, Olinga P, Havenga K. Mucus Microbiome of Anastomotic Tissue During Surgery Has Predictive Value for Colorectal Anastomotic Leakage. Ann Surg. 2019 May;269(5):911-916. doi: 10.1097/SLA.0000000000002651.

Reference Type BACKGROUND
PMID: 29303807 (View on PubMed)

Gaines S, Shao C, Hyman N, Alverdy JC. Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery. Br J Surg. 2018 Jan;105(2):e131-e141. doi: 10.1002/bjs.10760.

Reference Type BACKGROUND
PMID: 29341151 (View on PubMed)

Nagata N, Tohya M, Fukuda S, Suda W, Nishijima S, Takeuchi F, Ohsugi M, Tsujimoto T, Nakamura T, Shimomura A, Yanagisawa N, Hisada Y, Watanabe K, Imbe K, Akiyama J, Mizokami M, Miyoshi-Akiyama T, Uemura N, Hattori M. Effects of bowel preparation on the human gut microbiome and metabolome. Sci Rep. 2019 Mar 11;9(1):4042. doi: 10.1038/s41598-019-40182-9.

Reference Type BACKGROUND
PMID: 30858400 (View on PubMed)

Papp G, Saftics G, Szabo BE, Baracs J, Vereczkei A, Kollar D, Olah A, Meszaros P, Duboczki Z, Bursics A. Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial. Br J Surg. 2021 Apr 5;108(3):271-276. doi: 10.1093/bjs/znaa131.

Reference Type BACKGROUND
PMID: 33793743 (View on PubMed)

Williamson AJ, Alverdy JC. Influence of the Microbiome on Anastomotic Leak. Clin Colon Rectal Surg. 2021 Nov 23;34(6):439-446. doi: 10.1055/s-0041-1735276. eCollection 2021 Nov.

Reference Type BACKGROUND
PMID: 34853567 (View on PubMed)

Di Segni A, Braun T, BenShoshan M, Farage Barhom S, Glick Saar E, Cesarkas K, Squires JE, Keller N, Haberman Y. Guided Protocol for Fecal Microbial Characterization by 16S rRNA-Amplicon Sequencing. J Vis Exp. 2018 Mar 19;(133):56845. doi: 10.3791/56845.

Reference Type BACKGROUND
PMID: 29608151 (View on PubMed)

Reuvers JRD, Budding AE, van Egmond M, Stockmann HBAC, Twisk JWR, Kazemier G, Abis GSA, Oosterling SJ; SELECT trial group. Gut Proteobacteria levels and colorectal surgical infections: SELECT trial. Br J Surg. 2023 Jan 10;110(2):129-132. doi: 10.1093/bjs/znac288. No abstract available.

Reference Type BACKGROUND
PMID: 35998096 (View on PubMed)

Other Identifiers

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Surgi-Comics_01

Identifier Type: -

Identifier Source: org_study_id

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