Influence of Esophageal Washout on Local Carcinoma Recurrence After Curative Resection (LOCARE)

Technische Universität Dresden

Status: Completed

Conditions: Esophageal Neoplasms

Treatments: Drug: Povidone-Iodine

Study type: Interventional

Funder types: Other

Identifiers

NCT02676791

VTG-07

Details and patient eligibility

About

The LOCARE-Trial is an investigator initiated, randomized-controlled trial with two parallel arms (n=60 each) and investigates the influence of esophageal washout on long-term outcomes in patients undergoing elective esophageal resection for carcinoma. The primary endpoint is defined as local carcinoma recurrence. Secondary endpoints will be locoregional and distant recurrence, disease-specific survival and esophageal cancer specific survival.

Full description

Treatment of squamous cell carcinoma and adenocarcinoma of the esophagus has changed rapidly over the last decades due to implementation of multimodal cancer therapies such as radiotherapy or combined radiochemotherapy. Surgery, however, still is the mainstay of curative treatment options for this cancer entity. Due to the significant improvement in surgical technique and perioperative management, the postoperative mortality rate has fallen to about 5% with an estimated 5-year survival of 35%. Nevertheless, patients after esophagectomy are at high risk for local recurrence especially within the first 2 years after treatment. Independent risk factors for the development of carcinoma recurrence are incomplete resection (R1), extracapsular lymph node involvement and postoperative complications. Exfoliated, malignant cells remaining in luminal organs like the esophagus or colorectum could present another important risk factor for local recurrence especially at the site of anastomosis. In the treatment of rectal cancer, data have shown, that intraoperative rectal washout significantly reduces the risk of local recurrence from about 10% to 5%. For this reason, rectal washout during anterior resection has become a standard in many surgical institutions. Besides agents like cetrimide, sodium hypochlorite, formalin or saline, povidone-iodine has also been used for rectal mucosal application in prospective studies. Questions arise, weather similar positive outcomes could be achieved in esophageal surgery. The investigators hypothesize that esophageal washout with a povidone-iodine solution (Betaisodona®, Mundipharma) reduces the risk of local carcinoma recurrence after radical resection.

Enrollment: 80 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients scheduled for elective esophageal resection or esophagectomy
• Age equal or greater than 18 years
• Written informed consent
• Squamous cell carcinoma of the esophagus (SCC)
• Adenocarcinoma of the gastroesophageal junction (AEG) Type I

Exclusion criteria

• Local irresectability or metastatic disease
• Adenocarcinoma of the gastroesophageal junction Type II and III
• Histopathological R1-resection
• Surgery for recurrence
• Iodine allergy
• Hyperthyreosis

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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80 participants in 2 patient groups

A (Povidone-Iodine)

Experimental group

Description:

Esophageal washout will be performed via a nasogastric tube with approx. 50ml of a 11% povidone-iodine solution (Betaisodona®, Mundipharma) during esophageal resection.

Treatment:

Drug: Povidone-Iodine

B (Control)

No Intervention group

Description:

Esophageal resection will be performed without esophageal washout.