Neoplasms

Digestive System Diseases

All Conditions

Symptoms and General Pathology

Rare Diseases

Behaviors and Mental Disorders

Stomach Neoplasms

Weight Loss

Esophageal Neoplasms

Body Weight

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Stomach Diseases

Stomach Cancer

Esophageal Cancer

Quality of Life

Antineoplastic Agents

Gastrointestinal Agents

All Drugs and Chemicals

Octreotide

Antineoplastic Agents, Hormonal

3 monthly intramuscular injections of 10 mg Octreotide

10 mg Sandostatin LAR intramuscular injection

Octreotide Injection

Fredrik Klevebro, MD, PhD

The aim of the study is to clarify whether octreotide therapy can reduce undesired postoperative weight loss, increase health-related quality of life and improve the appetite after surgery for esophageal or gastric cancer.

Dietary complications are the biggest problem for patients before, during and after surgical treatment. Improved multimodal therapy and centralization of treatment to highly specialized centers have led to an increase in the number of patients surviving with chronic negative effects of esophageal surgery. The scientific state of knowledge about HRQOL and the symptoms of long-term survival of esophageal cancer is limited.

Patient-reported outcome measures (PRUs) are results reported by the patient himself, e.g. HRQOL, remaining symptoms, satisfaction with health care and other problems in daily life. These results have rarely been of importance before but are now increasingly crucial in the evaluation of treatment. It is no longer just about survival for patients with cancer of the esophagus. The aim of the study is to clarify whether octreotide therapy can reduce undesired postoperative weight loss, increase health-related quality of life and improve the appetite after surgery for esophageal or gastric cancer.

Our hypothesis is that intramuscularly administered octreotide can decrease weight loss after gastrectomy or esophagectomy due to cancer and that it may improve postoperative health related quality of life. This study aims to investigate if postoperative eating problems can be reduced by treatment with octreotide in this patient group.

In the first part of the study: Sub study 1, safety, tolerability and feasibility of octreotide treatment will be investigated. Twenty patients diagnosed with esophageal or gastric cancer will receive three monthly injections of 10 mg of Sandostatin LAR depot. Patients will be followed up at 1, 2, 3 and 6 months for monitoring of safety blood parameters, changes in weight, health-related quality of life and adverse events.

In the second part of the study: Sub study 2, efficacy of treatment with octreotide will be studied. 152 patients diagnosed with esophageal or gastric cancer will be randomized 1:1 to post-surgical treatment with octreotide or no treatment. Patients in the active arm will receive three monthly injections of 10 mg of Sandostatin LAR depot. All patients will be followed up at 1, 2, 3 and 6 months in the same manner as in Sub study 1. In this study part gastrointestinal satiety hormones and nutritional evaluation associated quality of life will be studied in addition to body weight, body composition and health-related quality of life.

Parallell design with Control arm receiving standard treatment and Experimental arm receiving Octreotide treatment

Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer

Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer, a Prospective Randomized Open Label Phase II Study - OTIS

Weight loss in percent (%) from baseline weight before surgery, measured at 1, 2, 3, and 6 months after surgery

Measurement of S-GLP-1, S-PYY, S-Ghrelin and S-GIP (prior to octreotide administration), measured at baseline, 7 days post-surgery and after 1, 2, 3 and 6 months.

Body composition measured in percent (%) body fat (continuously)

Nutritional status measured with the questionnaire PG-SGA

Nutritional status measured with the questionnaire EORTC CAX24

Health-related Quality of Life (HRQOL) measured using EORTC QLQ-C30 at baseline and at 1, 2, 3 and 6 months after randomization

Health-related Quality of Life (HRQOL) measured using QLQ-OG25 at baseline and at 1, 2, 3 and 6 months after randomization

Percentage (of subjects) in need of enteral nutrition with a jejunostomy feeding catheter or nasogastric tube

Number and type of Adverse Events, including known AEs of Sandostatin LAR depot

Karolinska University Hospital

Fredrik Klevebro

Principal Investigator

Skin and Connective Tissue Diseases

Wounds and Injuries

Breast Neoplasms

Seroma

Inflammation

Received 100µg of octreotide intravenously 8-hourly for 5 days from the first post-operative day

Received 1ml of sterile water intravenously 8-hourly for 5 days from the first post-operative day

100µg of octreotide intravenously 8-hourly for 5 days from the first post-operative day

1ml of sterile water intravenously 8-hourly for 5 days from the first post-operative day

Sterile water

Ikechukwu B. Ulasi

Patients who had mastectomy for breast cancer usually have drainage of some fluid from the site of surgery. This could be prolonged and may lead to other negative consequences after surgery. Octreotide could potentially reduce the amount of this drainage. In this study, patients were grouped into two: a first group that received octreotide injection and a second group that received a placebo. The study tested whether octreotide injection has any effect on the duration of fluid drainage from the surgery site after mastectomy for breast cancer.

Study design and location: This was a randomised controlled trial carried out at the University College Hospital Ibadan, a premier teaching hospital in South West Nigeria.

Study population: Study participants were recruited from female breast cancer patients who presented through the Surgery Out-Patient (SOP) clinic of the University College Hospital, Ibadan to these general surgical divisions over the study period.

Sample size determination: Assuming a standard normal deviate (Zα/2) at 5% type I error of 1.96, standard normal variate for power (Zβ, at 80% power) of 0.84, standard deviation of 1.9 to detect a difference in mean duration of drain of 1.7 days, and an attrition rate of 5%, a sample size formula for comparing 2 independent means was used to obtain a total sample size of 41 study participants.

Sampling and randomisation technique: Convenience sampling of breast cancer patients presenting during the study period was employed. Study participants were randomized into 2 groups, a treatment and a control group, using blocked sequence randomization. Consecutive female breast cancer patients were prospectively enrolled in turns into the two study groups via the surgical out-patient department of the University College Hospital, Ibadan over the study period till the required sample size was attained. A computer-generated blocked randomisation sequence was used to insert the instruction "1" or "2" (representing treatment or control groups respectively) consecutively to 30 serially numbered envelopes, all of which were sealed afterwards.

Data collection: Data was obtained through a detailed history and physical examination and includes sociodemographic variables like age, occupation, educational status, religion and tribe. Other pre-operative data obtained included BMI, diagnosis, clinical (TNM) stage, histology, tumor grade, comorbidities and ASA grade. Intra-operative data obtained included cadre of surgeon, length of skin incision, intra-operative blood loss, total number of lymph nodes removed, weight of mastectomy specimen and duration of surgery. Post-operatively, the daily volume of wound drainage, post-operative day of drain and suture removal, total drain volume, time to drain removal, occurrence of seroma formation, frequency and duration of seroma aspirations and total number of positive lymph nodes on histology were recorded. All the above data were entered into a questionnaire proforma.

Procedure: All patients were admitted a day prior to surgery. Informed consent was obtained from all patients that met the inclusion criteria. Surgery was done under general anaesthesia and was performed by a consultant general surgeon or a senior registrar supervised by a consultant general surgeon.

Each patient was positioned supine and in slight reverse Trendelenburg position and the ipsilateral arm abducted at 90 degrees with a sandbag under the ipsilateral axilla. The skin was cleaned twice with savlon (chlorhexidine + cetrimide) followed by a single cleaning with 70% alcohol, each time from the level of the suprasternal notch to the umbilicus. The operation field was isolated using sterile drapes. An appropriate breast skin incision incorporating the nipple-areolar complex (with underlying breast mass and previous biopsy scar if any) was made and deepened to the subcutaneous tissue plane using monopolar diathermy. In all patients, electrocautery was used for skin flap dissection up to the clavicle superiorly, upper border of the rectus abdominis muscle inferiorly, sternum medially and the anterior axillary line laterally. Lane's tissue forceps was applied on the nipple-areolar areafor traction while Allis tissue forceps was applied on the flap edges for retraction. Removal of all breast tissue and pectoralis fascia began from the sternal border using a diathermy till the breast tissue was shaved off the pectoralis major muscle. A cuff of adjoining pectoralis major muscle was resected wherever the tumor was attached to the muscle or its fascia. The dissection was carried towards the axilla, stripping the fascia over the upper border of the rectus sheath and serratus anterior muscle, till the clavipectoral fascia was opened to gain access to the axillary fat and lymph nodes. Using blunt dissection, axillary clearance up to level III nodal area was done. During axillary clearance, the pectoralis minor was retracted to enable dissection of levels II and III nodes/fat. Haemostasis was secured using both electrocautery and ligatures. An improvised passive wound drain (urine bag; Meheco®, China) was inserted under the flaps and axilla to run from the lateral side of the wound up to the axilla and down to the medial side of the wound. The drain was brought out through a separate stab wound on the dependent side of the wound in the inferior flap and anchored using Silk 1 suture (Mersilk®, Ethicon). Wound closure was done in one layer using a disposable skin stapler (Advan®, China). All patients had an external wound dressing with meshed gauze over the incision site, followed by Gamgee dressing, which was held in place by a circumferential elastic bandage on the chest wall.

The sealed envelopes bearing the type of intervention was pulled serially with each consecutive patient on the morning of the first post-operative day. Patients in the treatment group were given 100µg of octreotide (Actide, Samarth®, India) intravenously(slowly over 3minutes) 8 hourly for 5days while those in the control group received 1ml of sterile water intravenously 8 hourly for 5days from the first post-operative day. The octreotide and sterile water for injection was administered by a designated surgical resident. Ipsilateral upper limb elevation above the shoulders was commenced with active but gentle upper limb exercises on the first post-operative day. Once daily emptying of the drain and recording of drain output was done by the ward nurses while the patients were on admission. In the first 4days after surgery, patients were shown how to empty the drainage bag and record the drainage volumes at home daily. Measurement of drainage fluid was done by first emptying the fluid in a container, then aspirating it in aliquots using a 10ml syringe till all fluid was aspirated and discarded and the total volume noted and recorded.

In compliance with the current unit protocol in my hospital, the mastectomy dressing was opened for initial wound review on the morning of the 5th postoperative day, following which another firm compression dressing was applied over the chest and axilla, in all patients. In the absence of an indication for continued hospital stay, patients were discharged home on the 5th post-operative day with their drains and were instructed to chart the daily drain output. The unit closed user group (CUG) number and my phone number were given to them in case of an emergency or need for a clarification/complaint. Further wound review was done on the 8th-12th post-operative day after removing the compression dressing. A drain output of \<40ml in the preceding 24hours was a criterion for drain removal.

Subsequent reviews were weekly till 28 days post-operatively at the surgical out-patient (SOP) clinic. During the clinic visits, they were assessed for seroma formation by a senior registrar blinded to the patients' randomization groups. Seroma was defined as clinically evident serous fluid collection at the operation site. Seroma was aspirated under aseptic technique with the volume, number and duration of aspirations recorded for each patient.

Data analysis: Descriptive statistics used for nominal variables (like histology, occupation) and ordinal data (like degree of BMI, ASA grade, disease stage, cadre of surgeon, level of axillary clearance) were proportions, rates and ratio while numerical variables (like age, volume of drain output, time to drain removal, frequency and volume of seroma aspirations) were analysed using means and standard deviations. Tables and graphs were used where applicable. Groups were compared primarily for the time to drain removal and total drain volume using the Mann Whitney-U test. Categorical variables (like incidence of seroma) were compared between the 2 groups using the Chi-square (χ2) or Fishers exact test as appropriate. The correlation between numerical perioperative factors with the time to drain removal and total drain output was analysed using Pearson or Spearman rank correlation as appropriate while the correlation between categorical perioperative factors with the time to drain removal and total drain output was analysed using the Kruskal-Wallis or Mann-Whitney U test as appropriate. Statistical significance was set at a p-value of \<0.05. Version 23 of the Statistical Package for Social Sciences for Windows was used to analyze all data obtained from the study.

Patients scheduled for modified radical mastectomy (MRM) were randomized into a treatment group that received 100µg of octreotide and a control group that received 1ml of sterile water intravenously 8-hourly for 5 days from the first post-operative day

The Effect of Octreotide on Wound Drainage After Mastectomy

The Effect of Octreotide on the Duration of Post-mastectomy Wound Drainage: a Randomized Controlled Trial

Time that elapsed from the day of surgery till the wound drain was removed

Clinically evident serous fluid collection at the operation site

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer	NCT04871204	Esophageal Canc... Gastric Cancer	Octreotide Inje...	18 Years -	Karolinska University Hospital
Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer	NCT04871204	Esophageal Canc... Gastric Cancer	Octreotide Inje...	18 Years -	Karolinska University Hospital
Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer	NCT04871204	Esophageal Canc... Gastric Cancer	Octreotide Inje...	18 Years -	Karolinska University Hospital
The Effect of Octreotide on Wound Drainage After Mastectomy	NCT05682209	Seroma Followin...	Octreotide Inje... Sterile water	-	University College Hospital, Ibadan
Octreotide Treatment to Improve Nutritional Recovery After Surgery for Patients With Esophageal or Gastric Cancer	NCT04871204	Esophageal Canc... Gastric Cancer	Octreotide Inje...	18 Years -	Karolinska University Hospital

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