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Remote Ischaemic Preconditioning in Intra-Abdominal Cancer Surgery (RIPCa): A Pilot Randomised Controlled Trial
Aikaterini Papadopoulou1,2, Matthew Dickinson3, Theophilus L Samuels4
1Department of Anaesthesia, King's College Hospital, London SE5 9RS, UK.
Journal of Clinical Medicine
|April 12, 2022
Summary
Remote ischaemic preconditioning (RIPC) may reduce surgical complications after major abdominal cancer surgery. This pilot study found RIPC feasible and associated with fewer postoperative complications, suggesting potential benefits for patient recovery.
Area of Science:
- Surgical Oncology
- Cardiovascular Physiology
- Critical Care Medicine
Background:
- Limited evidence exists on remote ischaemic preconditioning (RIPC) efficacy in non-cardiac surgery.
- Intra-abdominal cancer surgery poses significant risks for postoperative morbidity.
Purpose of the Study:
- To investigate the effect of RIPC on morbidity following intra-abdominal cancer surgery.
- To assess the feasibility of conducting a randomized controlled trial on RIPC in this patient population.
Main Methods:
- A double-blinded pilot randomized controlled trial involving 47 patients undergoing surgery for gynaecological, pancreatic, and colorectal malignancies.
- Intervention group received RIPC via intermittent upper limb tourniquet inflations; control group did not.
- Primary outcome was study feasibility; secondary outcomes included postoperative morbidity markers like troponin and urinary biomarkers (TIMP-2*IGFBP-7).
Main Results:
- The study met its recruitment target and protocol adherence was successful.
- The RIPC group showed significantly fewer surgical complications at 30 days (4.5% vs. 33%), 90 days (9.5% vs. 35%), and 6 months (11% vs. 41%).
- RIPC was independently associated with lower overall postoperative morbidity scores and reduced pulmonary, surgical, and overall complications at 6 months. No significant differences were observed in troponin or TIMP-2*IGFBP-7 levels.
Conclusions:
- Remote ischaemic preconditioning appears to be a feasible intervention that may improve outcomes in patients undergoing intra-abdominal cancer surgery.
- Findings suggest RIPC may reduce postoperative morbidity, warranting further investigation in larger clinical trials.
