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Schiffmann L, Becker M, Develing L, Varga-Szabo D, Scheidereiter-Krüger C, Zirngibl H, Seifert M, Biermann L, Schlüter C, Tumczak F, Weimann A, Jansen-Winkeln B, Wallstabe I, Schwandner F, Denecke S, Schafmayer C, Kamaleddine I, Stier A, Haegele K, Kindler M, Michling S, Horling EW, Denzer U. SEVTAR-A multicenter randomized controlled trial to investigate the impact of prophylactic endoluminal placed vacuum sponge for prevention of anastomotic leakage after low rectal resections. Front Surg 2023; 9:1099549. [PMID: 36860727 PMCID: PMC9968789 DOI: 10.3389/fsurg.2022.1099549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 02/15/2023] Open
Abstract
Background Low anterior resection for rectal cancer is commonly associated with a diverting stoma. In general, the stoma is closed 3 months after the initial operation. The diverting stoma reduces the rate of anastomotic leakage as well as the severeness of a potential leakage itself. Nevertheless, anastomotic leakage is still a life-threatening complication and might reduce the quality of life in the short and long term. In case of leakage, the construction can be converted into a Hartmann situation or it could be treated by endoscopic vacuum therapy or by leaving the drains. In recent years, endoscopic vacuum therapy has become the treatment of choice in many institutions. In this study, the hypothesis is to be evaluated, if a prophylactic endoscopic vacuum therapy reduces the rate of anastomotic leakage after rectal resections. Methods A multicenter parallel group randomized controlled trial is planned in as many as possible centers in Europe. The study aims to recruit 362 analyzable patients with a resection of the rectum combined with a diverting ileostoma. The anastomosis has to be between 2 and 8 cm off the anal verge. Half of these patients receive a sponge for 5 days, and the control group is treated as usual in the participating hospitals. There will be a check for anastomotic leakage after 30 days. Primary end point is the rate of anastomotic leakages. The study will have 60% power to detect a difference of 10%, at a one-sided alpha significance level of 5%, assuming an anastomosis leakage rate of 10%-15%. Discussion If the hypothesis proves to be true, anastomosis leakage could be reduced significantly by placing a vacuum sponge over the anastomosis for 5 days. Trial registration The trial is registered at DRKS: DRKS00023436. It has been accredited by Onkocert of the German Society of Cancer: ST-D483. The leading Ethics Committee is the Ethics Committee of Rostock University with the registration ID A 2019-0203.
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Affiliation(s)
- Leif Schiffmann
- Department of Visceral and General Surgery, Helios Klinikum Aue, Aue, Germany,Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany,Correspondence: Leif Schiffmann
| | - Matthias Becker
- Department of Visceral and General Surgery, Helios Weißeritztal-Kliniken GmbH—Klinikum Freital, Freital, Germany
| | - Leendert Develing
- Department of Visceral and General Surgery, University Hospital Wuppertal, Wuppertal, Germany
| | - David Varga-Szabo
- Department of Visceral and General Surgery, University Hospital Wuppertal, Wuppertal, Germany
| | | | - Hubert Zirngibl
- Department of Visceral and General Surgery, University Hospital Wuppertal, Wuppertal, Germany
| | - Michael Seifert
- Department of Visceral and General Surgery, Helios Klinikum Erfurt, Erfurt, Germany
| | - Lothar Biermann
- Department of Visceral and General Surgery, Joseph Hospital Warendorf, Warendorf, Germany
| | - Claudia Schlüter
- Department of Visceral and General Surgery, Joseph Hospital Warendorf, Warendorf, Germany
| | - Felicitas Tumczak
- Department of Visceral and General Surgery, University Hospital Wuppertal, Wuppertal, Germany
| | - Arved Weimann
- Department of Visceral and General Surgery, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral and General Surgery, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Ingo Wallstabe
- Department of Gastroenterology, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Frank Schwandner
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
| | - Sandra Denecke
- Department of Visceral and General Surgery, University Hospital Wuppertal, Wuppertal, Germany
| | - Clemens Schafmayer
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
| | - Imad Kamaleddine
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
| | - Albrecht Stier
- Department of Visceral and General Surgery, Helios Klinikum Erfurt, Erfurt, Germany
| | - Katharina Haegele
- Department of Visceral and General Surgery, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Michael Kindler
- Department of Visceral and General Surgery, Helios Weißeritztal-Kliniken GmbH—Klinikum Freital, Freital, Germany
| | - Sabine Michling
- Department of Visceral and General Surgery, Klinikum Kaufbeuren, Kaufbeuren, Germany
| | - Ernst-Wilhelm Horling
- Department of Visceral and General Surgery, Klinikum Kaufbeuren, Kaufbeuren, Germany
| | - Ulrike Denzer
- Department of Gastroenterology, Marburg University Hospital, Marburg, Germany
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