ACROBATIC Welcomes Five New Affiliated Research Projects

ACROBATIC is pleased to welcome five new affiliated research projects that address key challenges in modern cancer surgery. Together, the projects focus on improving patient outcomes through better risk assessment, optimised perioperative care, innovative surgical strategies, and high quality clinical data with direct relevance to everyday practice.

WP 1.9
WP leader: Michael Achiam, Professor, DMSc., Ph.d., MD, Department of Digestive Diseases, Transplantation and General Surgery, Rigshospitalet, Denmark.
Title: Preoperative evaluation and prehabilitation in esophagogastric cancer surgery.
Abstract:
Background: Esophagogastric cancer predominantly affects older adults, and despite advances in surgical care, >50% of patients undergoing curative surgery develop postoperative complications. Complications worsen survival and quality of life and substantially increase healthcare costs (up to 241% after complicated esophagectomy). The preoperative period provides a window for optimisation, yet evidence for prehabilitation remains inconsistent, partly due to heterogeneous, single-modality interventions and inclusion of relatively fit patients. A decentralised, multimodal approach targeting high-risk patients may improve outcomes and reduce social inequality in line with Kræftplan V.

Hypothesis/Aim: We hypothesise that a national, decentralised, multimodal prehabilitation programme is feasible and safe and can reduce postoperative morbidity in high-risk patients. The primary aim is to evaluate feasibility and safety and estimate the impact on postoperative morbidity to inform a definitive national RCT.
Methods: In a national, multicentre feasibility pilot, 60 high-risk patients scheduled for curatively intended esophagectomy will be recruited from four Danish cancer centres. High risk is defined by ≥1 risk factor (low physical function, frailty, malnutrition risk, daily smoking, and/or harmful alcohol intake). The tailored intervention includes decentralised home/municipality-based exercise, Comprehensive Geriatric Assessment, dietitian-led nutrition, and smoking/alcohol cessation. Primary endpoints are recruitment, retention, adherence, and adverse events; secondary endpoints include morbidity, length of stay, readmissions, mortality, and patient/relative/staff-reported experiences and preferences.
Perspectives: This study will deliver a scalable national framework for implementation and provide effect estimates and feasibility data for a subsequent RCT and health economic evaluation.

WP 1.10
WP leader: Helle Ø Kristensen, MD Ph.D., Department of Surgery, Aarhus University Hospital, Denmark.
Title: Inferior Mesenteric Artery Occlusive Disease and Its Association with Anastomotic Leakage After Restorative Rectal resection for Rectal Cancer Protocol for a case-control study.
Abstract:
Background: Anastomotic leakage (AL) is a serious and potentially life-threatening complication following restorative rectal resection (RRR) for rectal cancer, with substantial consequences for postoperative morbidity, quality of life, and potentially delayed adjuvant chemotherapy. Adequate anastomotic perfusion is essential for healing, and atherosclerotic occlusive disease of the mesenteric arteries—particularly the inferior mesenteric artery (IMA)—may compromise blood supply and healing resulting in increased risk of AL.
Aim: The primary aim is to study the association between IMA occlusive disease and AL after RRR. A central objective is to generate results that are directly applicable to patients benefitting from a multicentre design including two high-volume centres Aarhus University Hospital (AUH) and Zealand University Hospital (SUH).
Methods: In this multicentre case–control study, consecutive patients undergoing RRR with primary anastomosis for rectal adenocarcinoma between 2020 and 2024 at AUH and SUH will be included. Patients with clinically confirmed AL will be matched. Preoperative staging CT scans will be independently and blinded assessed by experienced radiologists using a standardised protocol to evaluate IMA stenosis, collateral circulation, and generalised atherosclerosis. The association between AL and IMA stenosis will be assessed statistically using logistic regression.
Implications: Identification of mesenteric occlusive disease as a preoperative risk factor may enable personalised risk assessment, inform shared decision-making, and guide preventive strategies such as prehabilitation, protective stoma formation, or alternative surgical approaches. Ultimately, this may reduce AL, improve quality of life, and improve oncological outcomes for patients undergoing rectal cancer surgery.

WP 1.11
WP leader: Tommy Kjærgaard Nielsen, MD, PhD, Associate Professor, Department of Urology, Aalborg University Hospital, Denmark.
Title: ROB’N’SAFE: Robot-assisted radical nephrectomy as a safe same-day procedure.
Abstract:
Robot-assisted radical nephrectomy (RARN) is a well-established treatment for localized kidney cancer. With that being said, identifying frail patients at increased risk of postoperative complications remains a key challenge to future same-day RARN.
The project aims to identify key predictors to refine preoperative frailty assessment by identifying key predictors of postoperative complications to refine patient selection and develop targeted pre- and postoperative care strategies.
The following three studies will be conducted:
Study I: A prospective observational cohort study assessing preoperative predictors of frailty and their impact on same-day discharge feasibility. Variables include Clinical Frailty Scale, handgrip strength, chair stand test, CT-derived body composition, and wearable-derived biometric data. Primary outcome: 24-hour readmission rate. Secondary outcomes: 30-day complications and readmission, health literacy, and patient reported quality of life.
Study II: An observational cohort study evaluating postoperative recovery in relation to frailty, using validated questionnaires and pain management assessments. Primary outcome: Patient-reported quality of recovery. Secondary outcomes: opioid consumption, functional recovery metrics, and frailty progression.
Study III: A qualitative study exploring the role of relatives in supporting patients postoperatively, focusing on preparedness, satisfaction, and health literacy in home-based care.
Our expected outcomes include improved patient selection criteria for same-day RARN through integration of wearable technology, CT-based body composition analysis, and AI-driven predictive models, ultimately optimizing surgical safety. Furthermore, insights into the role of relatives in postoperative support may strengthen home-based care while increasing confidence and reassurance among healthcare professionals and patients.

WP 2.31
WP leader: Tine Engberg Damsgaard, MD, PhD, MRBS, Professor, Research Unit of Plastic Surgery, Odense University Hospital, Department of Plastic Surgery, Odense University Hospital, Department of Surgery and Plastic Surgery, University Hospital of Southern Denmark and Department of Regional Health Research, Denmark.
Title: SENSI-Breast: Restoring Sensation after Breast Reconstruction: A Clinical Study of Neurotization Techniques
Abstract:
Loss of breast and nipple sensation after nipple-sparing mastectomy with immediate reconstruction significantly affects quality of life. Although awareness of sensory outcomes is increasing, techniques for sensory preservation and restoration are still emerging and require systematic clinical evaluation to support safe, standardized integration into patient-centered reconstructive practice.
SENSI-Breast is a prospective clinical research program designed in accordance with the IDEAL framework to evaluate the feasibility, safety, and effectiveness of sensory nerve reconstruction in immediate breast reconstruction following mastectomy. The project comprises four substudies: a systematic review, a feasibility study, and two prospective case-control studies comparing standard reconstruction without neurotization, direct end-to-end nerve coaptation using a nerve connector, and neurotization using an interpositional nerve allograft.
Primary outcomes include objective sensory recovery assessed by Semmes–Weinstein monofilament testing and patient-reported sensory outcomes and quality of life measured using the validated BREAST-Q questionnaire. Outcomes are assessed longitudinally up to 24 months postoperatively. Results from the feasibility study will inform subsequent sample size calculations and guide methodological refinement.
The project is anchored at a high-volume breast reconstructive center and is conducted through close collaboration between plastic surgeons, breast surgeons, sensory research specialists, statisticians, and patient representatives. National and international collaborations support methodological rigor and enable gradual expansion to additional centers as technical training and feasibility are established.
By integrating objective sensory testing with patient-reported outcomes, SENSI-Breast aims to generate clinically relevant evidence to support sensory restoration as a meaningful outcome in breast reconstruction and ultimately improve long-term quality of life for breast cancer survivors.

WP 2.32
WP leader: Frederik Ferløv Thomsen, Associate Professor, MD, PhD, Department of Urology, Zealand University Hospital, Roskilde, Denmark.
Title: Comparative Understanding of Renal Tumour Management in Denmark - A National Prospective Cohort Study (CURE-RCC)
Abstract:
Increasing incidental detection of kidney cancers has raised concerns about overtreatment of small renal masses, while new treatment modalities have been widely adopted without robust comparative evidence to guide personalised care.
CURE-RCC is a Danish national, prospective cohort study designed to address these critical evidence gaps by generating high-quality, real-world data across the full spectrum of contemporary management strategies for non-metastatic RCC. The study will enrol 5,920 patients managed with active surveillance, ablation therapy, partial nephrectomy, or radical nephrectomy across all eight Danish urological centres. Using a target trial emulation framework and modern causal inference methods, CURE-RCC will enable valid comparative effectiveness analyses in a setting where randomised trials have proven infeasible. Short-term outcomes include patient-reported quality of life, including emotional distress and postoperative recovery, while long-term follow-up will capture oncological outcomes, renal function, cardiovascular events, and sustained quality of life. The nationwide design ensures comprehensive inclusion, reduces selection bias, and ensures direct applicability to routine clinical practice.
The study is anchored within DaRenCa, ensuring national ownership, multidisciplinary collaboration, and long-term continuity. Participation from all relevant urological, radiological, and oncological centres enables complete population coverage and harmonised data collection. Together, this will support patient-centred, value-based kidney cancer care by informing clinical guidelines with robust real-world evidence, reducing unwarranted treatment costs, and evaluating the influence of socioeconomic and geographic factors on treatment selection and outcomes.