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27th August 2022

ACROBATIC at Danish Cancer Research Days 2022

Danish Research Center for Cancer Surgery (ACROBATIC) participated at Danish Cancer Research Days 2022, where the aim was to share knowledge and initiate collaboration across professional groups, specialities and institutions for the benefit of cancer patients.

Danish Cancer Research Days 2022 (Danske Kræftforskningsdage 2022) is the country’s largest interdisciplinary cancer conference and was held in Kolding from 25th to 26th of August. The framework of the conference is knowledge sharing and collaboration across professional groups, specialties and regions – to the benefit of patients. The conference is thus a cornerstone of the collaboration between DCCC and DMCG.dk, and in the spirit of ACROBATIC.

Many of ACROBATIC’s members participated in the conference, and some also presented their ACROBATIC projects. The Center Leader, Professor and Senior Consultant Abdominal Surgeon Lene Hjerrild Iversen, MD PhD gave an oral presentation about the strategy and vision of ACROBATIC during the session “Cancer Surgery – National and interdisciplinary collaboration improves survivorship and quality of life”.

Mads Hvid Aaberg Poulsen (WP 2.4), Thomas Baad-Hansen (WP 2.11), and Therese Juul (WP 3.1) presented their ACROBATIC projects at the poster session:

WP 2.4: WP leader Mads Hvid Aaberg Poulsen

Title: Introduction of Salvage Robot-Assisted Radical Prostatectomy in Denmark.

Introduction: The goal was to introduce robot-assisted salvage prostatectomy (sRARP) as a nationwide option for the more than 100 Danish patients who yearly experience relapse after radiotherapy for high-risk prostate cancer (PCa). Here we present the pilot series and describe the initial experience with sRARP in a Danish context. The study was anchored within the Danish Prostate Cancer Group (DaProCa) and was funded by the Danish Health Authorities. We aim to establishment for two centers, which covers the entire population. The primary endpoints were peri-operative safety and early functional outcome.

Materials and methods: Between April 2020 and July 2021, 18 potential candidates for sRARP underwent screening. All patients underwent PSMA-PET/CT, prostate MRI and transrectal prostate biopsy. Thirteen patients were excluded based on metastatic disease (7), extensive comorbidity (3), inoperable (2), and patient preference (1). The remaining 5 patients all underwent sRARP. All included patients had biochemical recurrent disease after standard external beam radiation with 78Gy/39 fractions with 3 years of androgen deprivation.

Results: The median age of the included patients was 71 years and their median PSA at surgery was 3.8 ng/ml (range 2.2-4.0). All patients were discharged within 48 hours and no major complications were observed within 3 months. One patient experienced vesicourethral anastomosis leakage was treated conservatively. At follow-up 3 months after surgery all patients reported considerable incontinence. For patients with 12 month or longer follow-up, pad usage decreased to 1 or 2 pads daily. All patients had unmeasurable PSA (<0,1ng/ml) at 9 months after surgery. For patients with longer follow-up than 9 months, PSA remained unmeasurable for all but one patient. Median follow up was 15 months.

Conclusion: In the pilot series, sRARP appears safe without major per- or postoperative complications. In addition, sRARP appers to offer good tumor control.

WP 2.11: WP leader Thomas Baad-Hansen

Title: Improving sarcoma survival – implementing 3D print technology in complex sarcoma surgery.

Introduction: Sarcoma is a life-treating disease, which is particularly resistant to both chemo- and radiotherapy therefore surgical treatment of sarcomas is an essential part of a comprehensive management. Free fibula grafts are to date commonly used in reconstruction after sarcoma resection in the meta- or diaphysis, however, nonunion does occur because of improper stability, blood supply or alignment. CARLO (Cold Ablation Robot-guided Laser Osteotome) is a miniaturized robotic laser system that is able to cut interlocking dovetail osteotomies. We hypothesis that interlocking osteotomies could markedly increase initial bony stability, which in return will lower the risk of nonunion.

Materials and methods: This study will use 8 sheep that were bred for scientific purposes. 4 sheep will be randomized to interlocking osteotomies and 4 will be randomized to conventional internal fixation. The 4 sheep randomized to interlocking osteotomies will be initially CT-scanned and the acquired imaging data will be used to virtually plan interlocking dovetail osteotomies which will be subsequently fixated using a biodegradable screw. The 4 sheep undergoing conventional internal fixation will have a transverse osteotomy performed in the radius area using an oscillating saw, and will be fixated with an internal osteosynthesis plate and screws according to the AO principles. The sheep will be euthanized after 6 weeks. The mechanical properties of the two groups will be tested in terms of torsional and shear strength. The mechanical tests will be performed as destructive load tests and the bone reconstructions will be tested until failure by means of push-out tests. Healing will be assessed using histomorphometric analysis to histologically and quantitatively assesses the amount of newly formed bone.

Marie Ikast Drejer (right) presented the work of WP 3.1 (WP leader Therese Juul). She is posing together with Henriette Vind Thaysen (left) and Ida Hovdenak (middle), who are also part of the project.
Marie Ikast Drejer (right) presented the work of WP 3.1 (WP leader Therese Juul). She is posing together with Henriette Vind Thaysen (left) and Ida Hovdenak (middle), who are also part of the project.

WP 3.1: WP leader Therese Juul

Title: Patient-led follow-up with the use of digital solutions to increase self-management.

Introduction: Recent studies concerning patient-led follow-up have shown positive effect on rectal cancer patients’ management of symptoms and timely reporting of clinical symptoms. This project’s main task is to transfer each of the steps in the patient’s follow-up pathway into a digital care guide, which will provide the patients with an overview of the complete follow-up pathway. The digital care guide will in addition contain educational material regarding common long-term sequelae and signs of cancer recurrence, instructions on how to manage and react adequately to these symptoms, and how to contact the healthcare system.

Materials and Methods: The follow-up pathway for rectal cancer patients will be transferred into a digital care guide, using the platform “Emento” which delivers a digital care guide for the health care system. The content will be based on a previously developed analogue educational session used in a randomised trial, including long-term sequelae (physical and psychological) and signs of recurrence. A digital symptom guide will be introduced for the patients at the initiation of follow-up and be available throughout follow-up. The guide will provide information on how to self-manage symptoms, and where to take contact if needed. In addition, the patients will have access to unrestricted self-referral to a clinical nurse. Relevant stakeholders will be involved in developing the digital care guide, including patients, doctors, nurses and secretaries.

Results: The development of the digital care guide is initiated in May 2022, followed by a feasibility study, measuring participation rate, quantity and patterns of digital activities, knowledge, patient experienced barriers and facilitators, self-management, fear of recurrence and health literacy in 50 rectal cancer patients.

Conclusions: If successful, the present study will immediately be advantageous to both the patient’s and to the society by improved self–management and patient satisfaction.