Intraoperative Neuromonitoring of Pelvic Autonomous Nerve Plexus During Total Mesorectal Excision
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ClinicalTrials.gov Identifier: NCT04949646 |
Recruitment Status :
Recruiting
First Posted : July 2, 2021
Last Update Posted : March 13, 2024
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Condition or disease | Intervention/treatment | Phase |
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Rectal Neoplasms | Other: Pelvic Intraoperative Neuromonitoring | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 44 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | The study will employ a prospective, parallel randomized-controlled design |
Masking: | Single (Participant) |
Masking Description: | The patient will be blinded regarding the allocation group. Blinding will not exist at the level of the surgeon, the anaesthesiologist, and the investigator responsible for the data recording |
Primary Purpose: | Treatment |
Official Title: | Intraoperative Neuromonitoring of Pelvic Autonomous Nerve Plexus During Total Mesorectal Excision |
Actual Study Start Date : | September 19, 2021 |
Estimated Primary Completion Date : | September 19, 2026 |
Estimated Study Completion Date : | September 19, 2027 |
Arm | Intervention/treatment |
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Experimental: pIONM
In the experimental group pIONM will be performed intraoperatively. For the implementation of pIONM, a special device, that allows simultaneous monitoring of sphincter signals and bladder manometry, will be introduced. This device will employ the placement of a bipolar electrode in the internal and external anal sphincter. Moreover, another electrode will be placed on the surrounding tissues. For bladder manometry, the catheter will be connected to the pressure sensor, and subsequently to the pIONM monitor. Intraoperatively, depending on the approach (open or laparoscopic), the respective bipolar stimulator will be used. Prior to the initiation of pIONM, urinary bladder will be drained and filled with 200 ml R/L. The pIONM parameters will be the following: 1-25 milliampere current, 30 Hz frequency and 200 μs monophasic pulses. |
Other: Pelvic Intraoperative Neuromonitoring
Pelvic Intraoperative Neuromonitoring (pIONM) allows mapping of the pelvic autonomous plexus during total mesorectal excision (TME). |
No Intervention: Control
In the control group pIONM will not be performed intraoperatively
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- Change in the quality of life of the patient at 3 months postoperatively, based on the SF-36 questionnaire [ Time Frame: Preoperatively, 3 months postoperatively ]Change in the quality of life of the patient, at 3 months postoperatively, compared to the respective preoperative measurements, based on the Short Form 36 (SF-36) questionnaire SF-36: Short Form Survey Minimum Value: 0 Maximum Value: 100 Higher scores indicate a better outcome
- Operative time [ Time Frame: Intraoperative period ]The total operative time will be recorded. Measurement unit: minutes
- Intraoperative bleeding [ Time Frame: Intraoperative period ]The total intraoperative blood loss volume will be recorded. Measurement unit: mL
- Postoperative discharge time [ Time Frame: Maximum time frame 15 days postoperatively ]Postoperative time that the patient can be safely discharged. Measurement unit: hours. The patient will be discharged, when it is ensured that is medically safe to be released. In particular, as the exit time of the patient, will be regarded the time that the patient will fulfil the Clinical Discharge Criteria. More specifically, the patient should meet the following : steady vital signs, be oriented, without nausea or vomiting, mobilized with a steady gait, without a significant bleeding
- Postoperative complications [ Time Frame: 1 month postoperatively ]Occurrence of postoperative complications (based on Clavien-Dindo classification). If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- Negative resection margin [ Time Frame: 1 month postoperatively ]Occurrence of negative resection margin. If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- Local recurrence [ Time Frame: 1 year postoperatively ]Occurrence of local recurrence. If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- Bladder capacity [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of bladder capacity. Measurement unit: ml
- Bladder compliance [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of bladder compliance. Measurement unit: ml/cm H2O
- Detrusor pressure at maximum flow [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of detrusor pressure at maximum flow. Measurement unit: cm H2O
- Maximum urinary flow rate [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of maximum urinary flow rate. Measurement unit: ml/s
- Voiding volume [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of voiding volume. Measurement unit: ml
- Post-void residual [ Time Frame: Preoperatively and 2 months postoperatively ]Urodynamic assessment. Evaluation of post-void residual. Measurement unit: ml
- Anal canal resting phase pressure [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of anal canal resting phase pressure. Measurement unit: mmHg
- Sphincter zone length [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of sphincter zone length. Measurement unit: cm
- Short squeeze test [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of short squeeze (5sec) pressure. Measurement unit: mmHg
- Long squeeze test [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of long squeeze (30sec) pressure. Measurement unit: mmHg
- Cough test [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of cough test (0 and 50 ml). If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- Push test [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of push test (0 and 50 ml). If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- RAIR test [ Time Frame: Preoperatively and 2 months postoperatively ]High-resolution Anorectal Manometry assessment. Evaluation of rectoanal inhibitory reflex (RAIR) test (20 and 50 ml). If such an episode occurs, then it will be defined as=1 'YES' If such an episode does not occur, then it will be defined as=0 'NO'
- Difference in the quality of life of the patient, based on the SF-36 questionnaire [ Time Frame: Preoperatively, 6, 12, 24 months postoperatively ]Difference in the quality of life of the patient, at 6, 12, 24 months postoperatively, compared to the respective preoperative measurements, based on the Short Form 36 (SF-36) questionnaire SF-36: Short Form Survey Minimum Value: 0 Maximum Value: 100 Higher scores indicate a better outcome
- Difference in the erectile function of the patient, based on the IIEF questionnaire [ Time Frame: Preoperatively, 3, 6, 12, 24 months postoperatively ]Difference in the erectile function of the patient, at 3, 6, 12, 24 months postoperatively, compared to the respective preoperative measurements, based on the International Index of Erectile Function (IIEF) questionnaire IIEF: International Index of Erectile Function Minimum Value: 0 Maximum Value: 5 Higher scores indicate a better outcome
- Difference in the sexual function of the patient, based on the FSFI questionnaire [ Time Frame: Preoperatively, 3, 6, 12, 24 months postoperatively ]Difference in the sexual function of the patient, at 3, 6, 12, 24 months postoperatively, compared to the respective preoperative measurements, based on the Female Sexual Function Index (FSFI) questionnaire FSFI: Female Sexual Function Index Minimum Value: 2 Maximum Value: 36 Higher scores indicate a better outcome
- Difference in the prostate symptoms of the patient, based on the IPSS questionnaire [ Time Frame: Preoperatively, 3, 6, 12, 24 months postoperatively ]Difference in the prostate symptoms of the patient, at 3, 6, 12, 24 months postoperatively, compared to the respective preoperative measurements, based on the International Prostate Symptom Score (IPSS) questionnaire IPSS: International Prostate Symptom Score Minimum Value: 0 Maximum Value: 35 Higher scores indicate a worse outcome
- Difference in the low anterior syndrome symptoms of the patient, based on the LARS questionnaire [ Time Frame: Preoperatively, 3, 6, 12, 24 months postoperatively ]Difference in the low anterior syndrome symptoms of the patient, at 3, 6, 12, 24 months postoperatively, compared to the respective preoperative measurements, based on the Low Anterior Resection Syndrome (LARS) questionnaire LARS: Low Anterior Resection Syndrome Minimum Value: 0 Maximum Value: 42 Higher scores indicate a worse outcome
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Ages Eligible for Study: | 18 Years to 90 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Histologically confirmed rectal cancer
- Surgical resection with TME
- <90 years old
- Signed informed consent
Exclusion Criteria:
- Emergency operation
- Presence of pacemaker
- Partial mesorectal excision
- Sepsis or systematic infection
- Physical or mental impairment
- Pregnancy or nursing
- Insufficient preoperative data for the urogenital/ anorectal function
- Lack of compliance with the research process
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): NCT04949646
Contact: Konstantinos Tepetes, Prof | 00302413502804 | tepetesk@gmail.com | |
Contact: Konstantinos Perivoliotis, MD | 00302413501000 | kperi19@gmail.com |
Greece | |
University Hospital of Larissa | Recruiting |
Larissa, Greece, 41110 | |
Contact: Konstantinos Tepetes, Prof 00302413502804 tepetesk@gmail.com | |
Sub-Investigator: Anastasios Manolakis, PhD | |
Sub-Investigator: Michael Samarinas, PhD | |
Sub-Investigator: Aikaterini Tsiogga, MSc |
Study Director: | Konstantinos Tepetes, Prof | Department of Surgery, University Hospital of Larissa | |
Principal Investigator: | Konstantinos Perivoliotis, MD | Department of Surgery, University Hospital of Larissa |
Documents provided by Perivoliotis Konstantinos, Larissa University Hospital:
Responsible Party: | Perivoliotis Konstantinos, Perivoliotis Konstantinos, Principal Investigator, Larissa University Hospital |
ClinicalTrials.gov Identifier: | NCT04949646 |
Other Study ID Numbers: |
PelIONM |
First Posted: | July 2, 2021 Key Record Dates |
Last Update Posted: | March 13, 2024 |
Last Verified: | March 2024 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Plan Description: | No plan to share individual patient data |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
intraoperative neuromonitoring pelvic autonomous |
total mesorectal excision |
Rectal Neoplasms Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site |
Neoplasms Digestive System Diseases Gastrointestinal Diseases Intestinal Diseases Rectal Diseases |