POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection (PORSCH)
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|ClinicalTrials.gov Identifier: NCT03400280|
Recruitment Status : Recruiting
First Posted : January 17, 2018
Last Update Posted : June 14, 2019
|Condition or disease||Intervention/treatment||Phase|
|Pancreatic Diseases Pancreatic Neoplasms Pancreatic Cancer Pancreatitis||Other: Best practice algorithm for postoperative care||Not Applicable|
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.
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
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.
All centers performing pancreatic surgery in the Netherlands (i.e. the Dutch Pancreatic Cancer Group).
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.
Postoperative care according to current practice.
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.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||1600 participants|
|Intervention Model:||Crossover Assignment|
|Intervention Model Description:||Stepped-wedge cluster randomized trial|
|Masking:||None (Open Label)|
|Official Title:||POstopeRative Standardization of Care: THe Implementation of Best Practice After Pancreatic Resection. a Nationwide Stepped-Wedge Cluster Randomized Trial|
|Actual Study Start Date :||January 8, 2018|
|Estimated Primary Completion Date :||November 9, 2019|
|Estimated Study Completion Date :||February 9, 2020|
Experimental: Best practice
Postoperative care according to a best practice algorithm for postoperative care focussing on early detection and minimally invasive management of postoperative pancreatic fistula.
Other: Best practice algorithm for postoperative care
See arm/group description
No Intervention: Current practice
Postoperative care according to current usual practice.
- Composite primary endpoint [ Time Frame: 90 days after index pancreatic resection ]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
- Postoperative mortality [ Time Frame: 90 days after index pancreatic resection ]Measured as rate of death at 90-day follow-up
- New-onset organ failure [ Time Frame: 90 days after index pancreatic resection ]Measured as organ failure occuring any time within 90 days after resection, not present at time of index pancreatic resection.
- Late postpancreatectomy bleeding [ Time Frame: 90 days after 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.
- Postoperative morbidity [ Time Frame: 90 days after index 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).
- Adjuvant chemotherapy [ Time Frame: 90 days after index pancreatic resection ]Measured as number of patients receiving adjuvant chemotherapy at 90-day follow-up
- Success of implementation [ Time Frame: 90 days after index pancreatic resection ]Measured as number of patients in whom the algorithm was not followed and timing of abdominal CT scans in both strategies.
- Cost-effectiveness [ Time Frame: 90 days after index pancreatic resection ]Calculated by comparing health effects and medical costs related to both strategies up to 90 days after pancreatic resection.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03400280
|Contact: Jasmijn Smits, MDfirstname.lastname@example.org|
|Contact: Hjalmar C van Santvoort, MD, PhDemail@example.com|
|Principal Investigator:||Quintus Molenaar, MD, PhD||UMC Utrecht|
|Principal Investigator:||Hjalmar C van Santvoort, MD, PhD||St. Antonius Ziekenhuis|