Abdominal Massage After Colon Surgery for Cancer

Официальное название

Benefits of Abdominal Massage After Colon Surgery for Cancer Following an ERAS Protocol (MATRAC_Ter): a Multicenter, Prospective, Randomized Clinical Trial

Обзор

Postoperative ileus is a transient gastrointestinal dysmotility following abdominal surgery that leads to bloating, abdominal distention, visceral pain, nausea, vomiting, and delayed passage of flatus and stool. This paralytic state lasts longer when surgery involves the distal rather than the proximal digestive tract. Its incidence following colorectal surgery is between 10% and 30%. The main factors of postoperative ileus include age, predisposed constipation, method of anesthesia, type of surgical approach, perioperative analgesia, inflammatory reactions, and the psychopathology of the patient. Enhanced recovery after surgery (ERAS) provides patients with optimal means to counteract or minimize the deleterious effects of surgery, in particular toward minimizing postoperative ileus. Expert consensus among surgeons, anesthesiologists, physiotherapists, dieticians, and other team members has been reached that stated 24 clinical statements concerning preoperative, peroperative and postoperative periods that should be included in current rehabilitation programs in colorectal surgery. In China, massage, a 3000-year-old therapy guided by the theory of Yin and Yang, is widely used to treat various diseases. Chapelle and Bowe showed that abdominal massage reduced experimental postoperative ileus in a rat model and suggested that the effect was due to the attenuation of inflammation. Abdominal massage has not widely been applied after colorectal surgery. Due to the scarcity of literature on abdominal massage, it has never been considered to be part of ERAS recommendations in colorectal surgery. Nevertheless, massage involving profound maneuvering of the viscera through abdominal palpation and breathing has been used as part of the local postoperative protocol in our department for many years with interesting results, and no complication has been reported. To our knowledge, only one study has explored the effect of mechanical abdominal massage on the duration of ileus after colectomy. The aim of this prospective, multicenter randomized controlled trial (RCT) is to compare return of intestinal transit using the GI-2 criteria as defined by the time to first defecation and time to tolerance of solid food following the operation in two groups of patients following an ERAS protocol for colonic cancer surgery, one with and the other without early postoperative abdominal massage.

Вмешательства

• Другое ABDOMINAL MASSAGE
  Abdominal massage is not widely applied amongst general surgery team and is not part of the recommendation. This technique refers to profound manœuvrers of visceras through abdominal palpation and breathing, and has been used as part of the local protocol of Grenoble Alps University Hospital for many years with satisfactory results. No complications have been reported.
• Другое Usual physiotherapeutic intervention
  the usual physiotherapeutic intervention (respiratory and walking exercices). Each patients will be treated following the ERAS Guideline. - At D + 1post-surgical: 1 - First lift with verticalization. 2 - A session with the Cliniflo® in a seated position. 3 - Walk at least 100 m with the help of the physiotherapist. At- D + 2 and D + 3 post-surgical Same session as on D + 1 with progressive increase in the walking perimeter. Add up and down stairs on D+ 3 In this experimental arm, a abdominal mas

Первичные конечные точки

• Evaluate the effectiveness of abdominal massage on the resumption of digestive transit after colonic resection surgery for cancer as part of ERAS protocol. [Срок оценки: Through study completion, 30 days]

Критерии участия

Критерии включения

• Adults programmed to undergo surgery involving right, transverse or left colectomy due to cancer with anastomosis, regardless the approach (laparoscopy.
• Laparotomy and Robot-assisted). Patients must be able to follow the colorectal surgery unit's ERAS protocol.
• All included patients are required to have signed a study specific written informed consent form prior to inclusion in the trial.

Критерии исключения

• Patients required emergency surgery (obstruction or peritonitis),
• A stoma for whatever reason,
• Rectal cancer,
• BMI > 40,
• Psychiatric disorders,
• An associated procedure, extensive resection,
• Pregnancy, deprivation of liberty by judicial or administrative decision, or being under legal protection and patients with a hierarchical link to the principal investigator.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Поддерживающая терапия

Центры проведения

Франция · 1 центр

• CHU Grenoble Alpes — Grenoble

Публикации

• van Bree SH, Vlug MS, Bemelman WA, Hollmann MW, Ubbink DT, Zwinderman AH, de Jonge WJ, Snoek SA, Bolhuis K, van der Zanden E, The FO, Bennink RJ, Boeckxstaens GE. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Gastroenterology. 2011 Sep;141(3):872-880.e1-4. doi: 10.1053/j.gastro.2011.05.034. Epub 2011 May 26. PMID 21699777
• Le Blanc-Louvry I, Costaglioli B, Boulon C, Leroi AM, Ducrotte P. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg. 2002 Jan-Feb;6(1):43-9. doi: 10.1016/s1091-255x(01)00009-9. PMID 11986017
• Vincent D, Barbut M, Fisher J, et al. Is there any benefit to immediate postoperative abdominal massage in colorectal surgery? La revue de kinésithérapie 2026; in press
• Faucheron JL, Vincent D, Barbut M, Jacquet-Perrin I, Sage PY, Foote A, Quesada JL, Trilling B, Tidadini F. How long for gastrointestinal recovery following small bowel, right, or left colonic resection with anastomosis in a full fast-track recovery protocol? Int J Colorectal Dis. 2025 Apr 14;40(1):93. doi: 10.1007/s00384-025-04855-4. PMID 40229620
• Faucheron JL, Vincent D, Barbut M, Jacquet-Perrin I, Sage PY, Foote A, Bellier A, Quesada JL, Tidadini F, Trilling B. Abdominal massage to prevent ileus after colorectal surgery. A single-center, prospective, randomized clinical trial: the MATRAC Trial. Tech Coloproctol. 2024 Mar 22;28(1):42. doi: 10.1007/s10151-024-02914-6. PMID 38517591
• Wang Y, Xu J, Bao R, Li Z. Massage for gastrointestinal function among participants after abdominal surgery. A protocol for systematic review and meta-analysis. Medicine 21201.100(49):e28087 12. Chapelle SL, Bove GM. Visceral massage reduces postoperative ileus in a rat model. J Bodyw Mov Ther 2013;17:83-88
• Trilling B, Sage PY, Faucheron JL. What is fast track multimodal management of colorectal cancer surgery in real life? Tech Coloproctol. 2018 May;22(5):401-402. doi: 10.1007/s10151-018-1799-9. Epub 2018 Jun 1. No abstract available. PMID 29855815
• Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS(R)) Society Recommen PMID 30426190

Идентификаторы

NCT: NCT07713472 · 38RC26.0102

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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