SafeHeal Colovac Colorectal Anastomosis Protection Device evaluation (SAFE‐2) pivotal study: an international randomized controlled study to evaluate the safety and effectiveness of the Colovac Colorectal Anastomosis Protection Device

Author:

Hain Elisabeth1,Lefèvre Jérémie H.2ORCID,Ricardo Alison1,Lee Sang3,Zaghiyan Karen4,McLemore Elisabeth5,Sherwinter Danny6,Rhee Rebecca6,Wilson Matthew78ORCID,Martz Joseph9,Maykel Justin10,Marks John11,Marcet Jorge12,Rouanet Philippe13,Maggiori Leon14,Komen Niels15,De Hous Nicolas15ORCID,Lakkis Zaher16,Tuech Jean‐Jacques17,Attiyeh Fadi1,Cotte Eddy18,Sylla Patricia1

Affiliation:

1. Division of Colon and Rectal Surgery, Department of Surgery Icahn School of Medicine at Mount Sinai New York New York USA

2. Department of Digestive Surgery Sorbonne University, AP‐HP, Hôpital Saint Antoine Paris France

3. Division of Colon and Rectal Surgery, Department of Surgery University of Southern California Los Angeles California USA

4. Department of Surgery Cedars‐Sinai Medical Center Los Angeles California USA

5. Department of Colon and Rectal Surgery Kaiser Permanente Los Angeles Medical Center Los Angeles California USA

6. Department of Surgery Maimonides Medical Center Brooklyn New York USA

7. Department of Surgery Dartmouth‐Hitchcock Medical Center Lebanon New Hampshire USA

8. Geisel School of Medicine Dartmouth College Hanover New Hampshire USA

9. Division of Colon and Rectal Surgery Western Region Northwell/Lenox Hill Hospital New York USA

10. Division of Colon and Rectal Surgery UMass Memorial Medical Center Worcester Massachusetts USA

11. Department of Colorectal Surgery Lankenau Medical Center Wynnewood Pennsylvania USA

12. Division of Colon and Rectal Surgery, Department of Surgery University of South Florida Tampa Florida USA

13. Department of Colorectal Surgery Institut du Cancer de Montpellier Montpellier France

14. Department of Visceral and Digestive Surgery Saint Louis Hospital, AP‐HP Paris France

15. Department of Digestive Surgical Oncology and Liver Transplantation University Hospital of Besançon Besançon France

16. Department of Digestive Surgery Rouen University Hospital Rouen France

17. Department of Abdominal Surgery Antwerp University Hospital Wilrijkstraat 10 Edegem Belgium

18. Digestive and Oncological Surgery Hopital Lyon Sud Oullins‐Pierre‐Bénite France

Abstract

AbstractAimAlthough proximal faecal diversion is standard of care to protect patients with high‐risk colorectal anastomoses against septic complications of anastomotic leakage, it is associated with significant morbidity. The Colovac device (CD) is an intraluminal bypass device intended to avoid stoma creation in patients undergoing low anterior resection. A preliminary study (SAFE‐1) completed in three European centres demonstrated 100% protection of colorectal anastomoses in 15 patients, as evidenced by the absence of faeces below the CD. This phase III trial (SAFE‐2) aims to evaluate the safety and effectiveness of the CD in a larger cohort of patients undergoing curative rectal cancer resection.MethodsSAFE‐2 is a pivotal, multicentre, prospective, open‐label, randomized, controlled trial. Patients will be randomized in a 1:1 ratio to either the CD arm or the diverting loop ileostomy arm, with a recruitment target of 342 patients. The co‐primary endpoints are the occurrence of major postoperative complications within 12 months of index surgery and the effectiveness of the CD in reducing stoma creation rates. Data regarding quality of life and patient's acceptance and tolerance of the device will be collected.DiscussionSAFE‐2 is a multicentre randomized, control trial assessing the efficacy and the safety of the CD in protecting low colorectal anastomoses created during oncological resection relative to standard diverting loop ileostomy.Trial registrationNCT05010850.

Publisher

Wiley

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