General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description
Abstract Background Studies indicate that patients can be “seeded” with their own cancer cells during oncologic surgery and that the immune response to these circulating cancer cells might influence the risk of cancer recurrence. Preliminary data from animal studies and some retrospective analyses s...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Perioperative Medicine |
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| Online Access: | https://doi.org/10.1186/s13741-022-00290-z |
| _version_ | 1797952393210494976 |
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| author | Elliott Bennett-Guerrero Jamie L. Romeiser Samuel DeMaria Jacob W. Nadler Timothy D. Quinn Sanjeev K. Ponnappan Jie Yang Aaron R. Sasson |
| author_facet | Elliott Bennett-Guerrero Jamie L. Romeiser Samuel DeMaria Jacob W. Nadler Timothy D. Quinn Sanjeev K. Ponnappan Jie Yang Aaron R. Sasson |
| author_sort | Elliott Bennett-Guerrero |
| collection | DOAJ |
| description | Abstract Background Studies indicate that patients can be “seeded” with their own cancer cells during oncologic surgery and that the immune response to these circulating cancer cells might influence the risk of cancer recurrence. Preliminary data from animal studies and some retrospective analyses suggest that anesthetic technique might affect the immune response during surgery and hence the risk of cancer recurrence. In 2015, experts called for prospective scientific inquiry into whether anesthetic technique used in cancer resection surgeries affects cancer-related outcomes such as recurrence and mortality. Therefore, we designed a pragmatic phase 3 multicenter randomized controlled trial (RCT) called General Anesthetics in Cancer Resection (GA-CARES). Methods After clinical trial registration and institutional review board approval, patients providing written informed consent were enrolled at five sites in New York (NY) State. Eligible patients were adults with known or suspected cancer undergoing one of eight oncologic surgeries having a high risk of cancer recurrence. Exclusion criteria included known or suspected history of malignant hyperthermia or hypersensitivity to either propofol or volatile anesthetic agents. Patients were randomized (1:1) stratified by center and surgery type using REDCap to receive either propofol or volatile agent for maintenance of general anesthesia (GA). This pragmatic trial, which seeks to assess the potential impact of anesthetic type in “real world practice”, did not standardize any aspect of patient care. However, potential confounders, e.g., use of neuroaxial anesthesia, were recorded to confirm the balance between study arms. Assuming a 5% absolute difference in 2-year overall survival rates (85% vs 90%) between study arms (primary endpoint, minimum 2-year follow-up), power using a two-sided log-rank test with type I error of 0.05 (no planned interim analyses) was calculated to be 97.4% based on a target enrollment of 1800 subjects. Data sources include the National Death Index (gold standard for vital status in the USA), NY Cancer Registry, and electronic harvesting of data from electronic medical records (EMR), with minimal manual data abstraction/data entry. Discussion Enrollment has been completed (n = 1804) and the study is in the follow-up phase. This unfunded, pragmatic trial, uses a novel approach for data collection focusing on electronic sources. Trial registration Registered (NCT03034096) on January 27, 2017, prior to consent of the first patient on January 31, 2017. |
| first_indexed | 2024-04-10T22:45:37Z |
| format | Article |
| id | doaj.art-0dbb6a882f8648f8b6e55e05a29a1750 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-04-10T22:45:37Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-0dbb6a882f8648f8b6e55e05a29a17502023-01-15T12:17:06ZengBMCPerioperative Medicine2047-05252023-01-011211810.1186/s13741-022-00290-zGeneral Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol descriptionElliott Bennett-Guerrero0Jamie L. Romeiser1Samuel DeMaria2Jacob W. Nadler3Timothy D. Quinn4Sanjeev K. Ponnappan5Jie Yang6Aaron R. Sasson7Department of Anesthesiology, Renaissance School of Medicine at Stony, Brook UniversityDepartment of Anesthesiology, Renaissance School of Medicine at Stony, Brook UniversityDepartment of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount SinaiDepartment of Anesthesiology and Perioperative Medicine, University of Rochester School of MedicineDepartment of Anesthesiology, Preoperative Medicine and Pain Medicine, Roswell Park Comprehensive Cancer CenterDepartment of Anesthesiology, Long Island Jewish Medical Center at Northwell HealthDepartment of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook UniversityDepartment of Surgery/Surgical Oncology, Renaissance School of Medicine at Stony, Brook UniversityAbstract Background Studies indicate that patients can be “seeded” with their own cancer cells during oncologic surgery and that the immune response to these circulating cancer cells might influence the risk of cancer recurrence. Preliminary data from animal studies and some retrospective analyses suggest that anesthetic technique might affect the immune response during surgery and hence the risk of cancer recurrence. In 2015, experts called for prospective scientific inquiry into whether anesthetic technique used in cancer resection surgeries affects cancer-related outcomes such as recurrence and mortality. Therefore, we designed a pragmatic phase 3 multicenter randomized controlled trial (RCT) called General Anesthetics in Cancer Resection (GA-CARES). Methods After clinical trial registration and institutional review board approval, patients providing written informed consent were enrolled at five sites in New York (NY) State. Eligible patients were adults with known or suspected cancer undergoing one of eight oncologic surgeries having a high risk of cancer recurrence. Exclusion criteria included known or suspected history of malignant hyperthermia or hypersensitivity to either propofol or volatile anesthetic agents. Patients were randomized (1:1) stratified by center and surgery type using REDCap to receive either propofol or volatile agent for maintenance of general anesthesia (GA). This pragmatic trial, which seeks to assess the potential impact of anesthetic type in “real world practice”, did not standardize any aspect of patient care. However, potential confounders, e.g., use of neuroaxial anesthesia, were recorded to confirm the balance between study arms. Assuming a 5% absolute difference in 2-year overall survival rates (85% vs 90%) between study arms (primary endpoint, minimum 2-year follow-up), power using a two-sided log-rank test with type I error of 0.05 (no planned interim analyses) was calculated to be 97.4% based on a target enrollment of 1800 subjects. Data sources include the National Death Index (gold standard for vital status in the USA), NY Cancer Registry, and electronic harvesting of data from electronic medical records (EMR), with minimal manual data abstraction/data entry. Discussion Enrollment has been completed (n = 1804) and the study is in the follow-up phase. This unfunded, pragmatic trial, uses a novel approach for data collection focusing on electronic sources. Trial registration Registered (NCT03034096) on January 27, 2017, prior to consent of the first patient on January 31, 2017.https://doi.org/10.1186/s13741-022-00290-zCancer surgeryGeneral anesthesiaPropofolVolatile anesthesia |
| spellingShingle | Elliott Bennett-Guerrero Jamie L. Romeiser Samuel DeMaria Jacob W. Nadler Timothy D. Quinn Sanjeev K. Ponnappan Jie Yang Aaron R. Sasson General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description Perioperative Medicine Cancer surgery General anesthesia Propofol Volatile anesthesia |
| title | General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description |
| title_full | General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description |
| title_fullStr | General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description |
| title_full_unstemmed | General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description |
| title_short | General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description |
| title_sort | general anesthetics in cancer resection surgery ga cares randomized multicenter trial of propofol vs volatile inhalational anesthesia protocol description |
| topic | Cancer surgery General anesthesia Propofol Volatile anesthesia |
| url | https://doi.org/10.1186/s13741-022-00290-z |
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