Minimally Invasive Right Colectomy Anastomosis Study

Instituto de Investigación Marqués de Valdecilla1,200 enrolled

Overview

Right colectomy (hemicolectomy) involves the removal of the cecum, the ascending colon, the hepatic flexure, the first one-third of the transverse colon, part of the terminal ileum, and the associated regional fat and lymph nodes, and is the accepted treatment for malignant neoplasms of the right colon. A minimally invasive approach is commonly used for right colectomy, with studies reporting reduced complications, less blood loss, and hospital stay when compared to an open approach. However, there remains controversy regarding whether robotic assistance is advantageous for this technique and whether an intracorporeal (ICA) or extracorporeal anastomosis (ECA) is best. MIRCAST is a prospective, observational, international, multi-center, 4-parallel-cohorts study. Sites or surgeons will select a cohort of the study for which they are qualified. Four cohorts will be the subject of study: 1. Robotic Right Colectomy with ICA 2. Robotic Right Colectomy with ECA 3. Laparoscopic Right Colectomy with ICA 4. Laparoscopic Right Colectomy with ECA All patient assessments will be done according to the sites standard of care. Parameters routinely recorded during right colectomy surgery will be collected prospectively. Enrolled subjects will undergo assessments at the following intervals: pre-operative, operative, discharge, 30 days, 3 months, 1 year and 2 years post-surgery.

MIRCAST study is an observational, prospective, parallel cohorts, international, multi-center to compare robotic assisted and laparoscopic minimally invasive right colectomy, and intracorporeal anastomosis versus extracorporeal anastomosis. The research is coordinated by Marcos Gómez Ruiz MD PhD from Hospital Universitario Marqués de Valdecilla in Santander, Spain; the sponsorship is performed by Fundacion Instituto de Investigación Marqués de Valdecilla (IDIVAL). The European Society of Coloproctology (ESCP) endorses MIRCAST Study and will run a quality audit/independent monitoring of the study. The objectives of study are to compare of the peri-operative complications after robotic assisted and laparoscopic minimally invasive right colectomy with intracorporeal anastomosis versus extracorporeal anastomosis. To Identify potential benefits of robotic assisted procedures for right colon resections.

Study Type

OBSERVATIONAL

Enrollment

1,200

Interventions

Extracorporeal AnastomosisPROCEDURE

Anastomosis is performed by pulling out the bowel through a laparotomy wherever that laparotomy is performed.

Intracorporeal AnastomosisPROCEDURE

Anastomosis is performed inside the abdominal cavity with a laparoscopic or robotic technique

Robotic SurgeryPROCEDURE

Procedure is performed using robotic instruments

Laparoscopic SurgeryPROCEDURE

Procedure is performed using standard laparoscopic instruments

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or older. * Right colon tumor with indication for right colectomy (benign or malignant disease) * Patient has a life expectancy of at least 12 weeks * Patients with adequate performance status (Eastern Cooperative Oncology Group Scale score of ≤2) * Patient has signed and dated the Informed consent before patient inclusion in the study Exclusion Criteria: * Patient with a comorbid illness or condition that would preclude the use of surgery * Patients with cT4b tumors * Patients unwilling to comply with all follow-up study requirements * Patient undergoing emergency procedures * Planned colonic surgery along with major concomitant procedures (e.g. liver resections, other intestinal resections) * Metastatic disease * Pregnant or suspected pregnancy * Inflammatory Bowel Disease (Crohn´s Disease or Ulcerative Colitis)

Locations (32)

County Hospital Požega

Požega, Croatia

RECRUITING

Hospital of Southern Denmark

Aabenraa, Denmark

ACTIVE_NOT_RECRUITING

Zealand University Hospital

Køge, Denmark

ACTIVE_NOT_RECRUITING

Kanta-Hämeen Keskussairaala

Hämeenlinna, Finland

NOT_YET_RECRUITING

Outcomes

Primary Outcomes

Surgical wound infection

(CDC definition \[Health Protection Agency. Surveillance of Surgical Site Infection in England: October 1997-September 2005. London: Health Protection Agency; 2006): Superficial incisional, affecting the skin and subcutaneous tissue. These infections may be indicated by localised (Celsian) signs such as redness, pain, heat or swelling at the site of the incision or by the drainage of pus.

Time frame: 30 days

Clavien Dindo Complication

Complications according to Clavien Dindo Classification.

Time frame: 30 days

Secondary Outcomes

Overall Survival

The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive

Time frame: 2 years

Disease Free Survival (DFS)

Length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer.

Time frame: 2 years

Local Recurrence rate

Rate of cancer that has recurred at or near the same place as the original (primary) tumor

Time frame: 2 years

Distant metastases rate

Rate of Cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes

Time frame: 2 years

Rate of Unplanned Conversions to open surgery

When anything apart of the anastomosis had to be done through the laparotomy. If the anastomosis is not completely performed in an intracorporeal approach, the case is considered also converted

Time frame: 7 days

Operative time (min)

Operative time from skin to skin in minutes

Time frame: 7 days

Complete mesocolic excision (CME)

Complete Mesocolic Excision is defined as complete resection of the mesocolon with its anatomical envelope. Anatomical report should include any defect on CME specimen (Hohenberger W, Weber K., Matzel K., Papadopoulost T., Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation - technical notes and outcome. Colorectal Disease 11, 354-365 2008. doi:10.1111/j.1463-1318.2008.01735.x)

Time frame: 30 days

Number of Harvested Lymph Nodes

Number of harvested Lymph nodes according to the definitive pathological report.

Time frame: 30 days

R0 Resection

Rate of resection without any affected margins during the surgical procedure.

Time frame: 30 days

Length of Stay (LOS, days)

In hospital stay of the patient from the day that they are admitted before surgery to the day that they are fit to leave the hospital after the procedure.

Time frame: 3 months

Ventral hernia (assessed 1& 2 years after the right colectomy)

Incidence of ventral hernia 1 year after the procedure and 2 years after the procedure at the laparotomy site.

Time frame: 1 and 2 years after the procedure

Quality of Life Questionnaire (QLQ) of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30

Quality of Life Questionnaire (QLQ) of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 Score 3 months and 1 year after the procedure.

Time frame: 3 months and 1 year after the procedure

Quality of Life Questionnaire (QLQ) of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR29

Quality of Life Questionnaire (QLQ) of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR29 Score 3 months and 1 year after the procedure.

Time frame: 3 months and 1 year after the procedure

C-Reactive Protein value (CRP) days 1 & 3 postoperative

CRP values on postoperative day 1 and 3.

Time frame: 1 and 3 postoperative days.

Minimally Invasive Right Colectomy Anastomosis Study

Overview

Conditions

Interventions

Eligibility

Locations (32)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts