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Spots Global Cancer Trial Database for Preoperative Optimisation of Modifiable Risk Factors in Surgery of the Pancreas

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Trial Identification

Brief Title: Preoperative Optimisation of Modifiable Risk Factors in Surgery of the Pancreas

Official Title: Preoperative Optimisation of Modifiable Risk Factors in Surgery of the Pancreas: the Implementation of Best Practice Before Pancreatic Resection

Study ID: NCT05851534

Study Description

Brief Summary: 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: 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.

Eligibility

Minimum Age: 18 Years

Eligible Ages: ADULT, OLDER_ADULT

Sex: ALL

Healthy Volunteers: No

Locations

Amsterdam University Medical Center, Amsterdam, , Netherlands

OLVG, Amsterdam, , Netherlands

Amphia Hospital, Breda, , Netherlands

Jeroen Bosch Hospital, Den Bosch, , Netherlands

Catharina Hospital, Eindhoven, , Netherlands

Medisch Spectrum Twente, Enschede, , Netherlands

University Medical Center Groningen, Groningen, , Netherlands

Medisch Centrum Leeuwarden, Leeuwarden, , Netherlands

Leiden University Medical Center, Leiden, , Netherlands

Maatricht University Medical Center, Maastricht, , Netherlands

Radboud University Medical Center, Nijmegen, , Netherlands

Erasmus Medical Center, Rotterdam, , Netherlands

RAKU, Utrecht, , Netherlands

Contact Details

Name: Marcel den Dulk, MD PhD

Affiliation: Maastricht University Medical Center/ University Maastricht

Role: PRINCIPAL_INVESTIGATOR

Useful links and downloads for this trial

Clinicaltrials.gov

Google Search Results

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