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This study will evaluate, if an intensive individually adaptated training program via online supervision during neoadjuvant therapy will improve lung function and reduce pulmonary complications following esophagectomy for Barrett's cancer.
Patients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonal complications. This may be partly due to one-lung ventilation during the thoracic part of the operation. This often encounters for prolonged periods of reconvalescence and reduced quality of life, apart from socioeconomic disadvantages. Physical preconditioning has become a crucial leverage to optimize fitness and lung function in patients scheduled for esophagectomy, in particular during the interval of neoadjuvant therapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Internet-based exercise program | Experimental | The intervention group is supervised by a sports scientist eight to twelve weeks before and after surgery. Patients receive an individually designed intensive exercise program based on the functional and Fitness measurements at first diagnosis. |
|
| Basis therapy | No Intervention | Participants of the Treatment as usual (TAU) group receive written information material enlightening the importance of regular physical activities and general releases on preparation for esophagectomy. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Internet-based exercise program | Other | Patients undergo internet-based perioperative exercise program (iPEP), including daily endurance, resistance and ventilation training |
|
| Measure | Description | Time Frame |
|---|---|---|
| peak oxygen uptake (VO2peak) | First measurement three months prior to surgery (baseline), Second measurement immediately before surgery, third measurement three months after esophagectomy | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Gastric conduit failure after esophagectomy | (type classification according to Veeramootoo et al. (2009)) Evaluation of postoperative in-hospital stay | intraoperative |
| pneumonia | Evaluation of postoperative in-hospital stay |
| Measure | Description | Time Frame |
|---|---|---|
| feasibility of the online-based sports program | analysis by written questionnaire | 6 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Daniel Pfirrmann | Contact | +49 6131 392 3571 | pfirrma@uni-mainz.de |
| Name | Affiliation | Role |
|---|---|---|
| Perikles Simon, Prof.Dr.Dr. | Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg-University of Mainz | Principal Investigator |
| Ines Gockel, Prof. Dr. | Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Visceral, Transplantation, Vascular and Thoracic Surgery | Recruiting | Leipzig | 04103 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25629461 | Background | Gockel I, Niebisch S, Ahlbrand CJ, Hoffmann C, Mohler M, Duber C, Lang H, Heid F. Risk and Complication Management in Esophageal Cancer Surgery: A Review of the Literature. Thorac Cardiovasc Surg. 2016 Oct;64(7):596-605. doi: 10.1055/s-0034-1399763. Epub 2015 Jan 28. | |
| 22646630 | Background | van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. doi: 10.1056/NEJMoa1112088. |
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| ID | Term |
|---|---|
| D001471 | Barrett Esophagus |
| ID | Term |
|---|---|
| D011230 | Precancerous Conditions |
| D009369 | Neoplasms |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
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| intraoperative |
| duration of mechanical ventilation | Evaluation of postoperative in-hospital stay | intraoperative |
| re-intubation rate | Evaluation of postoperative in-hospital stay | intraoperative |
| Duration of intensive care unit stay | Evaluation of postoperative in-hospital stay | intraoperative |
| quality of life | Quality of life questionnaire (QoLQ-C30) with the esophagus-specific module OES-18. First measurement three months prior to surgery (baseline), immediately before surgery, three months after esophagectomy | 6 months |
| Principal Investigator |
| 22473157 | Background | Derogar M, Orsini N, Sadr-Azodi O, Lagergren P. Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery. J Clin Oncol. 2012 May 10;30(14):1615-9. doi: 10.1200/JCO.2011.40.3568. Epub 2012 Apr 2. |
| 22552194 | Background | Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012 May 19;379(9829):1887-92. doi: 10.1016/S0140-6736(12)60516-9. Epub 2012 May 1. |
| 19568723 | Background | Schwenk W. [Fast track rehabilitation in visceral surgery]. Chirurg. 2009 Aug;80(8):690-701. doi: 10.1007/s00104-009-1676-1. German. |
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| 12945027 | Background | Neal JM, Wilcox RT, Allen HW, Low DE. Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):328-34. doi: 10.1016/s1098-7339(03)00197-4. |
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| 19067058 | Background | Veeramootoo D, Parameswaran R, Krishnadas R, Froeschle P, Cooper M, Berrisford RG, Wajed SA. Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy. Surg Endosc. 2009 Sep;23(9):2110-6. doi: 10.1007/s00464-008-0233-1. Epub 2008 Dec 6. |
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| 15499604 | Background | Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, Nakamoto T, Nagasue N. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004 Nov 1;88(2):71-7. doi: 10.1002/jso.20137. |
| 24493117 | Background | Kumagai K, Rouvelas I, Tsai JA, Mariosa D, Klevebro F, Lindblad M, Ye W, Lundell L, Nilsson M. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg. 2014 Mar;101(4):321-38. doi: 10.1002/bjs.9418. Epub 2014 Feb 3. |
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| 21059667 | Result | Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011 Feb;25(2):99-111. doi: 10.1177/0269215510380830. Epub 2010 Nov 8. |
| 21309920 | Result | Feeney C, Reynolds JV, Hussey J. Preoperative physical activity levels and postoperative pulmonary complications post-esophagectomy. Dis Esophagus. 2011 Sep;24(7):489-94. doi: 10.1111/j.1442-2050.2010.01171.x. Epub 2011 Feb 10. |
| 23534776 | Result | Tatematsu N, Park M, Tanaka E, Sakai Y, Tsuboyama T. Association between physical activity and postoperative complications after esophagectomy for cancer: a prospective observational study. Asian Pac J Cancer Prev. 2013;14(1):47-51. doi: 10.7314/apjcp.2013.14.1.47. |
| 24604584 | Result | van Adrichem EJ, Meulenbroek RL, Plukker JT, Groen H, van Weert E. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study. Ann Surg Oncol. 2014 Jul;21(7):2353-60. doi: 10.1245/s10434-014-3612-y. Epub 2014 Mar 7. |
| 22489016 | Result | Dettling DS, van der Schaaf M, Blom RL, Nollet F, Busch OR, van Berge Henegouwen MI. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int. 2013 Mar;18(1):16-26. doi: 10.1002/pri.1524. Epub 2012 Apr 10. |
| 23113846 | Result | Agrelli TF, de Carvalho Ramos M, Guglielminetti R, Silva AA, Crema E. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study. Int Surg. 2012 Jul-Sep;97(3):198-202. doi: 10.9738/CC136.1. |
| 22409435 | Result | Inoue J, Ono R, Makiura D, Kashiwa-Motoyama M, Miura Y, Usami M, Nakamura T, Imanishi T, Kuroda D. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013 Jan;26(1):68-74. doi: 10.1111/j.1442-2050.2012.01336.x. Epub 2012 Mar 12. |
| 24767575 | Result | Valkenet K, Trappenburg JC, Gosselink R, Sosef MN, Willms J, Rosman C, Pieters H, Scheepers JJ, de Heus SC, Reynolds JV, Guinan E, Ruurda JP, Rodrigo EH, Nafteux P, Fontaine M, Kouwenhoven EA, Kerkemeyer M, van der Peet DL, Hania SW, van Hillegersberg R, Backx FJ. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial. Trials. 2014 Apr 27;15:144. doi: 10.1186/1745-6215-15-144. |
| 29789277 | Derived | Pfirrmann D, Haller N, Huber Y, Jung P, Lieb K, Gockel I, Poplawska K, Schattenberg JM, Simon P. Applicability of a Web-Based, Individualized Exercise Intervention in Patients With Liver Disease, Cystic Fibrosis, Esophageal Cancer, and Psychiatric Disorders: Process Evaluation of 4 Ongoing Clinical Trials. JMIR Res Protoc. 2018 May 22;7(5):e106. doi: 10.2196/resprot.8607. |
| 28615010 | Derived | Pfirrmann D, Tug S, Brosteanu O, Mehdorn M, Busse M, Grimminger PP, Lordick F, Glatz T, Hoeppner J, Lang H, Simon P, Gockel I. Internet-based perioperative exercise program in patients with Barrett's carcinoma scheduled for esophagectomy [iPEP - study] a prospective randomized-controlled trial. BMC Cancer. 2017 Jun 14;17(1):413. doi: 10.1186/s12885-017-3400-8. |
| D004066 |
| Digestive System Diseases |