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Lymphoedema of LegSurLymNCT05064176

Added Value of Reconstructive Lymphatic Surgery to Usual Care in Lymphoedema

A study testing Reconstructive lymphatic surgery in people with Lymphoedema of Leg and Lymphedema Arm, run by Universitaire Ziekenhuizen KU Leuven at 3 sites in Belgium.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The primary objective of this research proposal is to investigate in patients with lymphoedema of the upper limb or lower limb (P) the added value of reconstructive lymphatic surgery (I) to the decongestive lymphatic therapy (usual care) (C) on the lymphoedema-specific quality of life (QoL) (O) at 18 months… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lymphoedema of Leg, Lymphedema Arm, Lymphedema
What is being tested?
Reconstructive lymphatic surgery
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
180 participants
Where
3 sitesBelgium
Study dates
1 Feb 2022to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Unilateral or bilateral, primary or secondary lymphoedema of the upper or lower limb
  • If cancer-related lymphoedema, approval for participation in study from oncological specialist (patient participation has to be discussed during Multidisciplinary Oncological Consult); approval if:
  • estimated cancer-related survival is ≥3 years
  • oncological safety is guaranteed: for instance, time interval since radiotherapy/ chemotherapy is ≥3 months
  • Lymphoedema stage 1 to 2b
  • Objective diagnosis of lymphoedema: ≥ 5% volume difference OR ≥ 2 minor/ 1 major criteria on lymphoscintigraphy OR presence of IndoCyanineGreen (ICG) dermal backflow
Show all 9Show fewer
  • Score on Lymph-ICF questionnaire at screening: ≥ 25 / 100 (= moderate level of problems in functioning related to the development of lymphoedema)
  • History of at least 6 months of decongestive lymphatic therapy (DLT) until minimal pitting
  • Age ≥ 18 years

Who cannot join

  • Participants with history of liposuction, lymphovenous anastomosis, lymph node transfer
  • Pregnant participants
  • Severe obese participants: BMI>35
  • Estimated cancer-related survival is <3 years and oncological safety is not guaranteed (e.g. interval since radiotherapy/ chemotherapy is <3 months)
  • In case of lower limb lymphoedema: presence of chronic venous insufficiency C4, C5, C6; deep venous thrombosis; post-thrombotic syndrome
  • Allergy for ICG, iodine, penicillin and sulphonamides; increased activity of thyroid gland; benign tumour in thyroid; heparin use and severe renal insufficiency

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Belgium3 sites, 3 recruiting
  • Ghent University Hospital

    Ghent

    Caren Randon, PhD, Caren.randon@uzgent.be

    0032 9 332 34 49

    Recruiting
  • University Hospitals of Leuven, center for lymphedema

    Leuven, 3000

    Nele Devoogdt, PhD, 0032 16 342515, nele.devoogdt@uzleuven.be

    Tessa De Vrieze, PhD, 0032 16 34 50 06, tessa.devrieze@kuleuven.be

    Recruiting
  • CHU-UCL Mont-Godinne

    Namur

    Thierry Deltombe, PhD, Thierry.deltombe@uclouvain.be

    0032 81 42 37 72

    Recruiting

Other trials in Belgium

About this study

Official title: Comparison of Reconstructive Lymphatic Surgery Versus no Surgery, Additional to Decongestive Lymphatic Therapy (Usual Care), for the Treatment of Iymphoedema, Through a Multicentre Randomised Controlled Trial

The primary objective of this research proposal is to investigate

  • in patients with lymphoedema of the upper limb or lower limb (P)
  • the added value of reconstructive lymphatic surgery (I)
  • to the decongestive lymphatic therapy (usual care) (C)
  • on the lymphoedema-specific quality of life (QoL) (O)
  • at 18 months post-surgery/ no surgery (T)

Consequently, a multicentre pragmatic randomised controlled trial is performed to give an answer on following research question: 'Is, in addition to usual care - i.e. decongestive lymphatic therapy -, reconstructive lymphatic surgery (intervention group) superior to no surgery (control group), for the treatment of upper or lower limb lymphoedema?'

Read the detailed description

Lymphoedema is a chronic and often debilitating condition caused by lymphatic insufficiency. It leads to swelling of the limb and an increased risk of infection. It can be classified as primary (congenital) or secondary (acquired) lymphoedema.

Lymphoedema is very burdensome for the patient and therefore is it often associated with mental problems for example frustration and stress. In addition, because of the increase in volume of the limb, patients also develop physical problems, such as pain, heaviness, loss of strength, and develop functional problems, such as problems with household, mobility or social activities. These mental, physical and functional problems all have a negative impact on quality of life and have an influence on the ability to work. Consensus exist that the first choice of treatment is a conservative treatment. This conservative treatment consists of skin care, compression therapy (i.e. multilayer bandaging and compression garments), exercises and lymph drainage. Reconstructive lymphatic surgery is another option, also often performed: i.e. lymphovenous anastomoses, on the one hand, and a lymph node transfer, on the other hand. By (partially) restoring the lymphatic transport, the reconstructive lymphatic surgery may possibly lead to a larger decrease of the lymphoedema volume and therefore greater discontinuation of the compression garment. Consequently, patients will have an improvement in functioning and quality of life.

Currently, scientific evidence for reconstructive lymphatic surgery for the treatment of lymphoedema is missing. Therefore, the aim of this trial is to investigate the added value of reconstructive lymphatic surgery of the lymphatic system in addition to the conservative treatment, for the treatment of lymphoedema.

Being tested
Usual care, Reconstructive lymphatic surgery
Keywords
Reconstructive lymphatic surgery, Decongestive lymphatic therapy, Lymphovenous anastomosis, Lymph node transfer
Medical subject headings
Lymphedema

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Usual careOther

    Home physical therapist performs usual care and educates the patient to perform self-management

    Usual care:

    M1-6: 6 months of maintenance decongestive lymphatic therapy (DLT) (by patient and home physical therapist):

    • week 1-2: no physical therapy; patient performs limb elevation, muscle contractions and wears the bandage (intervention group)/ compression garment (control group)
    • week 3-4: start physical therapy, 2 days/ week: exercises, skin care \& manual lymph drainage (MLD), education; self-management by patient and wearing compression garment 14-16h/day (4 sessions) M2-6: 1 day/ week physical therapist: exercises, skin care \& MLD, and self-management by patient and wearing compression garment 14-16h/day (20 sessions)

    M7-12: 6 months of maintenance DLT by patient (self-management) and home physical therapist:

    • 1 day/week physical therapist: skin care, MLD, exercises (26 sessions) Month 13-18: 6 months of maintenance DLT by patient Month 19-36: 18 months of follow-up
  • Reconstructive lymphatic surgeryProcedure or surgery

    For the procedure of LVA:

    • Aim: making anastomoses of lymph vessels at the capillary level with a diameter of 0.3 to 0.8 mm, to redirect lymph to venous stream directly

    For the procedure of LNT:

    • Aim:
    1. Placed lymph nodes act as sponge to absorb lymphatic fluid and direct it into the vascular network;
    2. Placed lymph nodes induce lymphangiogenesis
Study groups in NCT05064176
Study groupRoleWhat they receive
Reconstructive lymphatic surgeryExperimentalThe intervention treatment is reconstructive lymphatic surgery and consists of the application of lymphovenous anastomosis (LVA), lymph node transfer (LNT) or a combination of both. The choice of reconstructive technique(s) is determined by the surgeon and is based on the algorithm for reconstructive lymphatic surgery of lymphoedema. Additionally, all patients receive usual care (i.e. maintenance decongestive lymphatic therapy)
Receives: Other: Usual care; Procedure: Reconstructive lymphatic surgery
No surgeryActive comparatorAll patients receive usual care (i.e. maintenance decongestive lymphatic therapy)
Receives: Other: Usual care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Lymphoedema-specific QoL (or problems in functioning related to development of lymphoedema)

    evaluated with the Dutch or French version of the Lymph-ICF questionnaire for upper or lower limb lymphoedema

    Measured: at 18 months

Secondary outcomes (16)
  1. Lymphoedema-specific QoL (or problems in functioning related to development of lymphoedema)

    evaluated with the Dutch or French version of the Lymph-ICF questionnaire for upper or lower limb lymphoedema

    Measured: at 1, 3, 6, 12 (short term) and 24, 36 (longer term) months

  2. General health-related QoL

    evaluated with the EuroQol-5D-5L questionnaire

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  3. Limb volume

    evaluated using circumference measures (ml)

    Measured: at 1, 3, 6, 12, 18 (key secondary outcome), 24, 36 months

  4. Failure to reduce the hours a day of wearing the compression stocking

    failure is defined as not able to continue the reduction of the hours of wearing the compression garment as stated by the protocol

    Measured: at 12, 18, 24, 36 months

  5. The hours of wearing the compression garment during one week

    evaluated with the International Compression Club (ICC) questionnaire ('dosage score' between 0-168h)

    Measured: at 12, 18 (key secondary outcome), 24, 36 months

  6. The experience of the compression garment

    evaluated with the International Compression Club (ICC) questionnaire ('comfort score' between 0-10 and 'complication score' between 0-10)

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  7. The physical activity level

    evaluated with the International Physical Activity Questionnaire (IPAQ) - short form (MET-hours/week)

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  8. The need for intensive treatment due to an increase in lymphoedema volume

    through interview

    Measured: at 6, 12, 18, 24, 36 months

  9. Body weight

    measured using a balance

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  10. Work capacity

    evaluated with the Work Productivity and Activity Impairment (WPAI-GH) questionnaire

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  11. Work ability

    evaluated with the Quickscan 18 (short form) questionnaire

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  12. Infection during the previous 18 months (yes/no)

    through interview

    Measured: at 18, 36 months (adverse events are collected during each clinical assessment but the amount of infections as secondary outcome are taken together for statistical analyses per 18 months)

  13. Complications of surgery

    through interview

    Measured: at 1, 3, 6, 12, 18, 24, 36 months

  14. Recurrence of cancer (yes/no)

    through medical file

    Measured: at 36 months

  15. Lymphatic transport

    through lymphoscintigraphy

    Measured: at 18 months

  16. Costs related to lymphoedema and its treatment during previous 18 months

    through interview

    Measured: at 18, 36 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Oct 2021
  2. Study start1 Feb 2022
  3. Primary completionJun 2025 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
180 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05064176
Sponsor's protocol ID
KCE19-1245
Acronym
SurLym
Status last verified
Jul 2024
First submitted
24 Aug 2021
Last updated
3 Jul 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual Participant Data (IPD) can be shared upon request.

Publications

  • Devoogdt N, De Vrieze T, Heroes AK, Bechter-Hugl B, Fieuws S, Godderis L, Segers K, Maleux G, Deltombe T, Frippiat J, Servaes M, Berners A, Fosseprez P, Krug B, Kayser F, Falticeanu A, Randon C, Monten C, Van Landuyt K, De Pypere B, Degraeve L, Decorte T, De Schryver M, Van Besien V, Devos D, Suominen S, Ayala JM, Pons G, Fourneau I, Thomis S. SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema. BMJ Open. 2024 May 10;14(5):e078114. doi: 10.1136/bmjopen-2023-078114.

    PubMed 38729754

Questions about this trial

What is this clinical trial studying?

A study testing Reconstructive lymphatic surgery in people with Lymphoedema of Leg and Lymphedema Arm, run by Universitaire Ziekenhuizen KU Leuven at 3 sites in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 3 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Nele Devoogdt (0032 16 34 25 15, nele.devoogdt@kuleuven.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Lymphoedema-specific QoL (or problems in functioning related to development of lymphoedema) (time frame: at 18 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05064176, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jul 2024.

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