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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has prolonged the survival substantially for selected patients with peritoneal metastases from colorectal cancer.Bleeding and thromboembolic disease have been reported as postoperative complications related to this advanced open surgical treatment. However, perioperative changes in coagulation and fibrinolysis are only sparsely reported in the literature.The mainstay of treatment with curative intend of none-advanced colorectal cancer is minimally invasive laparoscopic surgery followed by adjuvant chemotherapy. The approach is considered associated with a lower risk of thromboembolic disease than open surgery. Despite differences in extent of surgery and thromboembolic risk the same extended thromboprophylaxis regimen for 28 days is currently prescribed to patients undergoing cytoreductive surgery with HIPEC as well as minimally invasive rectal cancer resection. This study aims to investigate all parts of the coagulation system and fibrinolysis, and thereby thromboembolic risk and potential bleeding in two groups of patients with different extent of surgical trauma: 1) Colorectal cancer patients undergoing cytoreductive surgery with HIPEC and 2) rectal cancer patients undergoing minimal invasive rectal cancer resection. Our hypothesis is that patients undergoing cytoreductive surgery with HIPEC are exposed to more aggravated alterations of coagulation and fibrinolysis than patients undergoing minimally invasive rectal cancer resection.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 48 cytoreductive surgery with HIPEC patients | 48 patients with peritoneal metastases from colorectal cancer undergoing cytoreductive surgery with HIPEC (cytoreductive surgery with HIPEC patients) | ||
| 48 minimally invasive patients | 48 rectal cancer patients undergoing minimally invasive rectal cancer resection |
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| Measure | Description | Time Frame |
|---|---|---|
| The difference between changes in concentration of prothrombin fragment 1+2. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| Measure | Description | Time Frame |
|---|---|---|
| The difference between changes in platelet concentration from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. |
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Inclusion Criteria:
Cytoreductive surgery with HIPEC patients:
Minimally invasive rectal cancer patients:
Exclusion Criteria (both groups):
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This study will include patients with peritoneal metastases from colorectal cancer undergoing cytoreductive surgery with HIPEC and rectal cancer patients undergoing minimally invasive rectal cancer resection. Patients will be identified at the outpatient clinic and undergo surgical treatment at the Department of Surgery, Aarhus University Hospital, Denmark.
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| Name | Affiliation | Role |
|---|---|---|
| Anne-Mette Hvas, MD, PhD | Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aarhus University Hospital | Aarhus | Aarhus N | 8200 | Denmark | ||
| Thrombosis and Haemostasis Research Unit, Department for Clinical Biochemistry, Aarhus University Hospital |
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| Data will be analyzed, assessed, and presented within three years |
| The difference between changes in concentration of immature platelets from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years |
| The difference between changes in concentration of plasma selectin from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years |
| The difference between changes in activated partial thromboplastin time "APTT" (seconds) from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in international normalized ratio "INR" (seconds) from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of plasma fibrinogen from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of coagulation factor VIII from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of von wildebrand factor from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of thrombin-antithrombin complex from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in thrombin generation before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. Thrombin generation will be measured by: Lagtime (min), time to peak (min), peak thrombin (nM) and endogenous thrombin potential (nM*min). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes of fibrin clot structure from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference between changes of fibrin clot structure from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. Fibrin clot structure will be measured by clot maximum, absorbance (arbitrary units), network density, lysis time (seconds), lysis area (balance between clot formation and lysis). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of plasminogen activator inhibitor-1 from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of fibrin d-dimer from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in global hemostasis by Rotational thromboelastometry (ROTEM) from before surgery to the end of surgery (both groups) | The difference will be measured in blood samples from before surgery to the end of surgery (both groups). ROTEM will include EXTEM, INTEM, FIBTEM, and APTEM by clotting time (seconds), clot formation time (seconds), alpha-angle (degrees), amplitude 10 min after clotting time (mm), maximum clot firmness (mm), lysis index 30 min after clotting time (mm), maximum lysis (mm). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of syndecan-1 from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of sE-selectin from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of soluble thrombomodulin. from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of hemoglobin from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of leucocytes from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration C-reactive protein (CRP) from before surgery to the end of surgery in cytoreductive surgery with HIPEC patients and patients undergoing minimally invasive rectal cancer resection. | The difference will be measured in blood samples from before surgery to the end of surgery in cytoreductive surgery. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of prothrombin fragment 1+2. from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in platelet concentration from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of immature platelets from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in activated partial thromboplastin time "aPTT" (seconds) from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in activated international normalized ratio "INR" (seconds) from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of plasma fibrinogen from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of coagulation factor VIII from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of von wildebrand factor from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of thrombin-antithrombin complex from the end of cytoreductive surgery to the end HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in thrombin generation from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. Thrombin generation will be measured by: Lagtime (min), time to peak (min), peak thrombin (nM) and endogenous thrombin potential (nM*min). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes of fibrin clot structure from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. Fibrin clot structure will be measured by clot maximum, absorbance (arbitrary units), network density, lysis time (seconds), lysis area (balance between clot formation and lysis). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of plasminogen activator inhibitor-1 from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of fibrin d-dimer from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of global hemostasis measured by Rotational thromboelastometry (ROTEM) from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery to the end HIPEC. ROTEM will include EXTEM, INTEM, FIBTEM, and APTEM by clotting time (seconds), clot formation time (seconds), alpha-angle (degrees), amplitude 10 min after clotting time (mm), maximum clot firmness (mm), lysis index 30 min after clotting time (mm), maximum lysis (mm). | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of syndecan-1 from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of sE-selectin from the end of cytoreductive surgery to the end of HIPEC | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of soluble thrombomodulin from the end of cytoreductive surgery to the end of HIPEC | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of hemoglobin from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of leucocytes from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years. |
| The difference between changes in concentration of C-reactive protein (CRP) from the end of cytoreductive surgery to the end of HIPEC. | The difference will be measured in blood samples from the end of cytoreductive surgery (before HIPEC) to the end of HIPEC. | Data will be analyzed, assessed, and presented within three years |
| Incidence of deep vein thrombosis measured by doppler ultrasonography in colorectal cancer patients undergoing minimally invasive rectal cancer resection. | Bilateral doppler ultrasonography of the veins in the lower extremities.The scan will be performed within the postoperative period from day 3 to day 7. | Data will be analyzed, assessed, and presented within three years |
| Incidence of deep venous thrombosis measured by doppler ultrasonography in colorectal cancer patients undergoing cytoreductive surgery with HIPEC | Bilateral doppler ultrasonography of the veins in the lower extremities.The scan will be performed within the postoperative period from day 3 to day 7. | Data will be analyzed, assessed, and presented within three years |
| Aarhus N |
| 8000 |
| Denmark |
| ID | Term |
|---|---|
| D010534 | Peritoneal Neoplasms |
| D003110 | Colonic Neoplasms |
| D007414 | Intestinal Neoplasms |
| D054556 | Venous Thromboembolism |
| D006470 | Hemorrhage |
| D013927 | Thrombosis |
| D011183 | Postoperative Complications |
| D015179 | Colorectal Neoplasms |
| D009369 | Neoplasms |
| D012004 | Rectal Neoplasms |
| ID | Term |
|---|---|
| D000008 | Abdominal Neoplasms |
| D009371 | Neoplasms by Site |
| D004067 | Digestive System Neoplasms |
| D004066 | Digestive System Diseases |
| D010532 | Peritoneal Diseases |
| D005770 | Gastrointestinal Neoplasms |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D013923 | Thromboembolism |
| D016769 | Embolism and Thrombosis |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012002 | Rectal Diseases |
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