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Researchers from Radboudumc and University Hospital Leuven (Belgium) have received over two million euros of BeNeFit funding for research into a prevent strategy for infectious complications after esophageal resections for cancer. The research group is led by Camiel Rosman, Bastiaan Klarenbeek and Marjan de Vries. Regarding the PERSuaDER trial, there is very close cooperation with the RCI (Heiman Wertheim, Jeroen Schouten and Jaap ten Oever) and the thoracic surgery research group at the University Hospital Leuven (Hans van Veer).
Esophageal cancer is an extremely intrusive form of cancer destroying the swallowing tube connecting the mouth to the stomach. The most common curative treatment is removal and reconstruction of the swallowing tube. However, most patients undergoing esophagectomy are prone to develop infectious complications after surgery like pneumonia and anastomotic leakage which cause attributable morbidity and mortality. Microbiota of the oropharyngeal and digestive tract provide an important source of pathogens causing these infections. Eliminating these pathogens prior to surgery and during recovery may significantly decrease the risk of infectious complications, leading to better patient outcomes.
Selective decontamination of the digestive tract (SDD) is a prophylactic antibiotic strategy that aims to prevent infections, while being relatively low in cost. It consists of oral, non-absorbable antimicrobial agents reducing GI colonization with aerobic gram-negative rods and yeasts. Importantly, the positive effect of SDD on outcome has already been shown in ICU patients reducing ventilator associated pneumonia and for colorectal surgery - decreasing the rate of postoperative infections and anastomotic leakage. Given the high infectious complication risk after esophagectomy, SDD might be a promising and cost-effective strategy. However, before SDD can be integrated into standard care, robust and prospective evidence for its effectiveness in esophagectomy is needed.
PERSuaDER wants to answer this need by performing a randomized controlled trial to evaluate SDD as a potentially protective strategy for postoperative pneumonia and other infectious complications, anastomotic leakage and mortality in patients undergoing esophagectomy. Our aim is to prove that adding a simple intervention to standard care can significantly improve patients’ outcome in the Netherlands, Belgium and beyond.
