Neoplasms

Digestive System Diseases

Gland and Hormone Related Diseases

All Conditions

Symptoms and General Pathology

Rare Diseases

Pancreatic Neoplasms

Fistula

Pancreatitis

Pancreatic Diseases

Pancreatic Fistula

Gastrointestinal Neoplasms

Digestive System Neoplasms

Endocrine Gland Neoplasms

Gastrointestinal Diseases

Endocrine System Diseases

Pancreatic Cancer

Postoperative care according to a best practice algorithm for postoperative care focussing on early detection and minimally invasive management of postoperative pancreatic fistula.

Postoperative care according to current usual practice.

Best practice algorithm for postoperative care

Jasmijn Smits, MD

Hjalmar C van Santvoort, MD, PhD

Koop Bosscha

Marc Besselink

Sebastiaan Festen

Geert Kazemier

Jennifer Schreinemakers

Daphne Roos

Ignace de Hingh

Mike Liem

Vincent de Meijer

Fennie Wit

Bert Bonsing

Ronald van Dam

Marion van der Kolk

Casper van Eijck

Erwin van der Harst

Hjalmar van Santvoort

Quintus Molenaar

Gijs Patijn

Quintus Molenaar, MD, PhD

This Nationwide stepped-wedge cluster randomized trial is designed to evaluate if the implementation of a best practice algorithm for postoperative care results in a decrease in incidence of major complications and death after pancreatic resection as compared to current practice.

Rationale

Pancreatic resection is a major abdominal operation with 50% chance of postoperative complications. A feared complication is severe pancreatic fistula, in which there is leakage of enzyme rich fluid into the abdominal cavity. Adequate complication management appears to be the most important factor in improving outcomes of patients undergoing pancreatic resection.

Objective

To investigate whether implementation of a best practice algorithm for postoperative care focusing on early detection and step-up management of postoperative pancreatic fistula results in a lower rate of major complications and death after pancreatic resection as compared to current practice

Study design

A nationwide stepped-wedge, cluster randomized, superiority trial. In this design all participating centers cross over from current practice to best practice according to the algorithm, but are randomized to determine the exact order. At the end of the trial, all centers will have implemented the best practice algorithm.

Study population

All centers performing pancreatic surgery in the Netherlands (i.e. the Dutch Pancreatic Cancer Group).

Intervention

Cluster level education on postoperative care according to a best practice algorithm, focusing on early detection and step-up management of postoperative pancreatic fistula. This algorithm is based on findings in Dutch observational cohort studies, systematic literature analyses, an inventory in current protocols on postoperative care and expert opinion. The proposed algorithm is validated in a multicenter cohort and consensus upon this algorithm is reached with pancreatic surgeons from all centers of the Dutch Pancreatic Cancer Group. The final algorithm was reviewed critically by the advisory committee of internationally respected experts in the field of pancreatology before implementation in this trial.

Comparison

Postoperative care according to current practice.

Endpoints

The primary outcome was measured in all patients undergoing pancreatic resection and is a composite of major complications (i.e. postpancreatectomy bleeding, new-onset organ failure and death). Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, number of patients receiving adjuvant chemotherapy, healthcare resource utilization and costs analysis. Follow-up will be 90 days after pancreatic resection.

POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection

POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection. a Nationwide Stepped-Wedge Cluster Randomized Trial

The datasets generated during and/or analysed during the current study are/will be available upon request from Hjalmar van Santvoort (h.van.santvoort@antoniusziekenhuis.nl)

The primary endpoint of this trial is a composite of the most severe complications associated to postoperative pancreatic fistula. This endpoint will be considered positive if one of the following complications occurs within 90 days after pancreatic resection: late postpancreatectomy bleeding, new-onset organ failure and/or death

Measured as rate of death at 90-day follow-up

Measured as organ failure occuring any time within 90 days after resection, not present at time of index pancreatic resection.

Defined in accordance to the International Study Group on Pancreatic Surgery (ISGPS) definition as bleeding occurring any time after 24 hours after pancreatic resection.

Including complications according to the Clavien-Dindo system and pancreatectomy specific complications according to the ISGPS definitions (e.g. postpancreatectomy bleeding, postoperative pancreatic fistula, postoperative bile leak, postoperative chyle leak and delayed gastric emptying).

Measured as number of patients receiving adjuvant chemotherapy at 90-day follow-up

Measured as number of patients in whom the algorithm was not followed and timing of abdominal CT scans in both strategies.

Calculated by comparing health effects and medical costs related to both strategies up to 90 days after pancreatic resection.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection	NCT03400280	Pancreatic Dise... Pancreatic Neop... Pancreatic Canc... Pancreatitis	Best practice a...	-	St. Antonius Hospital
POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection	NCT03400280	Pancreatic Dise... Pancreatic Neop... Pancreatic Canc... Pancreatitis	Best practice a...	-	St. Antonius Hospital

Spots Global Cancer Trial Database for best practice algorithm for postoperative care