Preoperative Optimisation of Modifiable Risk Factors in Surgery of the Pancreas

NCT ID: NCT05851534

Last Updated: 2024-10-26

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

2575 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-02

Study Completion Date

2028-09-02

Brief Summary

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The goal of this stepped-wedge randomized controlled trial is to investigate whether implementation of a best practice program for preoperative optimisation (prehabilitation program) with a focus on screening, assessment, and intervention of 8 potentially (partly) modifiable risk factors in patients with (suspected) pancreatic cancer will improve outcome. The main questions it will aim to answer are:

1. Does a prehabilitation program improve the time to functional recovery after pancreatic surgery?
2. Does a prehabilitation program lead to a reduction in the Comprehensive Complication Index after pancreatic surgery?

Detailed Description

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Background In the past, little attention has been given in the daily practice to the patient's condition before an operation. Recent studies have shown the benefit of preoperative optimisation programs. However, these studies consisted only of smaller studies and were mainly performed in patients who underwent colorectal surgery. Although promising, unfortunately, strong evidence to support the contribution of prehabilitation to optimize the functional outcome after surgery is still lacking and consequently it is not included in the Dutch basic health insurance package.

Objective To investigate whether implementation of a best practice program for preoperative optimisation of patients with a focus on screening, assessment, and intervention of 8 potentially (partly) modifiable risk factors (low (aerobic) fitness level, malnutrition, low psychological resilience, comorbidities (iron deficiency (anaemia), impaired glucose control and frailty), and intoxications (alcohol and smoking behaviour)) will improve the time to functional recovery.

Study design A nationwide stepped-wedge cluster randomized trial. In this design all participating centres will cross over from current practice to the best practice program, in a randomised order. At the end of the study, all centres will have implemented the best practice program.

Study population 13 centres performing major pancreatic surgery in the Netherlands collaborating within the Dutch Pancreatic Cancer Group (DPCG).

Intervention Preoperative screening of all patients scheduled for pancreatic resection on (aerobic) fitness level, malnutrition risk, psychological resilience, haemoglobin, iron and HbA1c concentration, frailty, and alcohol and smoking behaviour. All patients are provided with a patient-tailored, multimodal prehabilitation program, in which these potentially (partly) modifiable factors are preoperatively addressed. This program is based on findings in previous screening and prehabilitation programs, a national inventory of current preoperative care protocols and expert opinion. Consensus upon this program was reached with pancreatic surgeons from all centres of the DPCG. The final program was critically reviewed by the advisory committee of internationally respected experts in the field of prehabilitation and pancreatology.

Comparison Preoperative care according to current practice.

Conditions

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Prehabilitation Pancreas Cancer Surgery Postoperative Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Stepped-wedge cluster randomized superiority trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Standard care

Receiving standard preoperative care

Group Type NO_INTERVENTION

No interventions assigned to this group

Best practice program

Implementation of best practice preoperative optimisation program

Group Type EXPERIMENTAL

Preoperative optimisation program

Intervention Type BEHAVIORAL

Preoperative screening of all patients scheduled for pancreatic resection on (aerobic) fitness level, malnutrition risk, psychological resilience, haemoglobin, iron and HbA1c concentration, frailty, and alcohol and smoking behaviour. All patients are provided with a patient-tailored, multimodal prehabilitation program, in which these potentially (partly) modifiable factors are preoperatively addressed

Interventions

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Preoperative optimisation program

Preoperative screening of all patients scheduled for pancreatic resection on (aerobic) fitness level, malnutrition risk, psychological resilience, haemoglobin, iron and HbA1c concentration, frailty, and alcohol and smoking behaviour. All patients are provided with a patient-tailored, multimodal prehabilitation program, in which these potentially (partly) modifiable factors are preoperatively addressed

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* All patients who are planned for a curative treatment with or without neoadjuvant treatment and elective pancreatic resection in one of the centres of the Dutch Pancreatic Cancer Group (i.e. all centres performing major pancreatic surgery)

Exclusion Criteria

* age \< 18 years
* acute pancreatic resections (resection scheduled within two weeks)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rising Tide Foundation

OTHER

Sponsor Role collaborator

Maastricht University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marcel den Dulk, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Maastricht University Medical Center/ University Maastricht

Locations

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Jeroen Bosch Hospital

's-Hertogenbosch, , Netherlands

Site Status RECRUITING

Amsterdam University Medical Center

Amsterdam, , Netherlands

Site Status RECRUITING

OLVG

Amsterdam, , Netherlands

Site Status RECRUITING

Amphia Hospital

Breda, , Netherlands

Site Status RECRUITING

Catharina Hospital

Eindhoven, , Netherlands

Site Status RECRUITING

Medisch Spectrum Twente

Enschede, , Netherlands

Site Status RECRUITING

University Medical Center Groningen

Groningen, , Netherlands

Site Status RECRUITING

Medisch Centrum Leeuwarden

Leeuwarden, , Netherlands

Site Status RECRUITING

Leiden University Medical Center

Leiden, , Netherlands

Site Status RECRUITING

Maatricht University Medical Center

Maastricht, , Netherlands

Site Status RECRUITING

Radboud University Medical Center

Nijmegen, , Netherlands

Site Status RECRUITING

Erasmus Medical Center

Rotterdam, , Netherlands

Site Status RECRUITING

RAKU

Utrecht, , Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Marcel den Dulk, MD PhD

Role: CONTACT

+3143 3875492

Heleen Driessens, MD

Role: CONTACT

+316 83058108

Facility Contacts

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Koop Bosscha, MD PhD

Role: primary

Marc Besselink, MD PhD

Role: primary

Tom Karsten, MD PhD

Role: primary

Jennifer Schreinemakers, MD PhD

Role: primary

Ignace de Hingh, MD PhD

Role: primary

Daan Lips, MD PhD

Role: primary

Joost Klaase, MD PhD

Role: primary

Eric Manusama, MD PhD

Role: primary

Sven Mieog, MD PhD

Role: primary

Marcel den Dulk, MD PhD

Role: primary

Kees van Laarhoven, MD PhD

Role: primary

Bas Groot Koerkamp, MD PhD

Role: primary

Hjalmar van Santvoort, MD PhD

Role: primary

Other Identifiers

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2023-3607

Identifier Type: -

Identifier Source: org_study_id

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