The present study will investigate the safety of inferior mesenteric artery embolization prior to rectal surgery, according to IDEAL recommendations (Lancet 2009). It aims to assess the safety of endovascular embolization of the inferior mesenteric artery prior to surgery in patients with rectal tumors, and estimate the potential benefits in terms of time to surgery and the occurrence of post-operative fistulas.The study will also assess the impact of subacute ischemia induced by IMA embolization on colonic vasculature remodeling, colonic ischemic suffering, altered hemostasis and initiation of neo-angiogenesis through blood sampling kinetics.The hypothesis is that ischemic preconditioning by inferior mesenteric artery embolization prior to rectal cancer resection surgery is safe and will result in a decrease in acute relative colon ischemia and a reduction in the rate of fistulas and post-surgical complications. Indeed, we believe that the beneficial effects of the ischemic preconditioning of IMA will be due to better blood perfusion of the colon at 3 weeks, which is apparently linked to remodeling and/or the development of collateral vascularization.
Anastomotic fistulas are the main cause of morbidity and mortality in colorectal surgery. They are responsible for septic complications, leading to increased mortality, local recurrence, repeat surgery and impaired sexual, urinary and digestive function. Fistulas are multifactorial; among the causes, colonic vascularization seems to be a major one. Ligation of the inferior mesenteric artery during rectal surgery has been shown to reduce intraoperative colonic perfusion flow. The left colon is then vascularized only by the colonic border arcade, perfused by the superior mesenteric artery. Ischemic pre-conditioning of the arterial network prior to surgery should ensure better vascularization by developing arterial collaterality and increasing perfusion flow in the colonic border arcade. In view of major advances in interventional radiology, this preconditioning could be achieved by endovascular ligation of the inferior mesenteric artery (IMA), based on the same principle as during surgery: proximal occlusion of the inferior mesenteric artery (IMA), using embolization material (plug or coils), 3 weeks before surgery, to allow the colonic border arcade to develop. We carried out a single-center pilot study (AMIREMBOL 1, NIMAO 2017; Frandon et al. 2022) to assess the feasibility of ischemic preconditioning of the colon for patients with rectal or sigmoid cancer. The study included 10 patients, randomized into two groups: the control group, with preoperative arteriography and standard management and the "embolization" group, with embolization of the IMA three weeks prior to surgery. IMA embolization was successfully performed in all 5 patients in the embolization group, with no major complications. The effect on colonic perfusion, measured by intraoperative Doppler directly on the border arch, with recording of resistance indexes (independent of measurement angle), showed a drop in resistance indexes in the control arm, after ligation of the IMA, which persisted after 5 minutes. In the "Embolization" arm, no drop in this index was reported during surgery, reflecting good development of vascular collaterality and at least relative acute ischemia of the colon after IMA ligation during surgery. Finally, in the "control" group, one anastomotic fistula was reported after surgery and required re-operation. There were no fistulas in the embolization group. The present study (AMIREMBOL 2) will investigate the safety of IMA embolization prior to rectal surgery, according to IDEAL recommendations (Lancet 2009). Its aim is to assess the safety of endovascular embolization of the IMA prior to surgery in patients with rectal tumors, and to estimate the potential benefits in terms of time to surgery and the occurrence of post-operative fistulas. The study will also assess the impact of subacute ischemia induced by IMA embolization on colonic vasculature remodeling, colonic ischemic suffering, altered hemostasis and initiation of neo-angiogenesis through blood sampling kinetics. The hypothesis is that ischemic preconditioning by inferior mesenteric artery (IMA) embolization prior to rectal cancer resection surgery is safe and will result in a decrease in acute relative colon ischemia and a reduction in the rate of fistulas and post-surgical complications. The hypothesis is that the beneficial effects of the ischemic preconditioning of IMA will be due to better blood perfusion of the colon at 3 weeks, which is apparently linked to remodeling and/or the development of collateral vascularization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Embolization performed via a common right femoral or radial approach, depending on the patient's conformation. Minor complications such as hematoma at the puncture site are rare in less than 1% of cases, and serious complications are exceptional. Proximal occlusion of the inferior mesenteric artery, before its dividing branches, using material adapted to arterial occlusion according to anatomical findings. Proximal occlusion during embolization is evaluated by intravascular injection into the inferior mesenteric artery, and resumption of vascularization of the distal inferior mesenteric artery is controlled by the border arcade injecting into the superior mesenteric artery. In the event of a high-risk anatomical variant, or absence of a border arcade, no embolization will be performed and the patient will be excluded from the study; this will represent no more than 1-2% of patients (surgical series describing 0.83% of ischemia in connection with absence of a border arcade).
The interventional radiologist performs an arteriogram of the inferior and superior mesenteric arteries (IMA and SMA respectively) to check that the SMA is free of anomalies and that the IMA has a proximal trunk long enough for embolization. The radiologist also checks for the presence of a colonic border arcade. If this is absent, embolization will not be performed: the patient will be excluded from the study.This arteriogram is carried out under local anaesthetic specifically for research purposes, as follows: Common right femoral or radial approach and placement of a small introducer. Selective arteriogram of the inferior and superior mesenteric arteries to check perfusion of the border arcade.Arterial closure system or manual compression. Return to surgery or interventional radiology department. Patient discharged the same day after medical assessment (surgeon or interventional radiologist).Telephone check-up on Day1 (standard management) and Day 7 (added as part of the protocol).
Hôpital Saint-Eloi
Montpellier, France
RECRUITINGInstitut du Cancer de Montpellier
Montpellier, France
RECRUITINGCHU de Nîmes
Nîmes, France
RECRUITINGSafety of endovascular inferior mesenteric artery embolisation prior to surgical resection of the rectum in patients with tumours of the lower and middle rectum.
Percentage of patients with a complication (any grade) within 7 days after embolisation of the inferior mesenteric artery according to the classification of the International Society of Interventional Radiology assessed during the follow-up telephone consultation by the interventional radiologist. Complications will be classified as minor (Grades A and B) or Major (grades C to F). Grade A = No therapy, no consequence Grade B = Nominal therapy, no consequence. Includes overnight admission for observation only Grade C = Requires therapy, minor hospitalization (\<48 hours) Grade D = Requires major therapy. Unplanned increase in level of care. Prolonged hospitalization (\>48 hours) Grade E = Permanent adverse sequelae Grade F= Death
Time frame: Day 7 post embolization (performed 3 weeks before surgical resection of the rectum)
Technical success of the embolization procedure
A control arteriogram of the inferior and superior mesenteric arteries will be carried out at the end of the embolisation procedure: intravascular injection into the inferior mesenteric artery and control of the resumption of vascularisation of the distal inferior mesenteric artery by the border arcade by injecting into the superior mesenteric artery. If embolisation fails, the patient will continue the study. The number of failures will be converted into a percentage
Time frame: Day 0, on the day of embolization
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade I
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade II
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade IIIa
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade IIIb
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade IVa
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade IVb
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Post-surgical complications up to 30 days after surgery. Clavien-Dindo Grade V
Percentage of patients presenting a post-operative complication according to the Clavien-Dindo Classification within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management. The Clavien-Dindo classification (Dindo et al 2004, Dindo D. 2004) classifies surgical complications into 7 categories (I, II, IIIa, IIIb, IVa, IVb and V)
Time frame: Post-operative Day 30
Rate of fistulas up to 30 days after surgery
Percentage of patients with a fistula within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management.A fistula will be identified either on the basis of clinical criteria (presence of pus or enteric contents in the drains, leakage of contrast medium through the anastomosis, anastomotic dehiscence during a repeat operation), or on the basis of radiological criteria (presence of an abdominal or pelvic collection in the area of the anastomosis on CT scan) if there is clinical doubt or if a CT scan is carried out for another reason (before stoma closure, for example).
Time frame: Day 0
Rate of fistulas up to 30 days after surgery
Percentage of patients with a fistula within 30 days of rectal surgery, assessed during hospitalization and at the 1-month post-surgical consultation, according to standard management.A fistula will be identified either on the basis of clinical criteria (presence of pus or enteric contents in the drains, leakage of contrast medium through the anastomosis, anastomotic dehiscence during a repeat operation), or on the basis of radiological criteria (presence of an abdominal or pelvic collection in the area of the anastomosis on CT scan) if there is clinical doubt or if a CT scan is carried out for another reason (before stoma closure, for example).
Time frame: Post-operative Day 30
Duration of post-surgical hospitalization
Length of hospital stay (number of days)
Time frame: Up to 30 days after rectal surgery
Degree of difficulty experienced by the visceral surgeon during surgery
Surgeon's assessment of degree of difficulty using a 4-point Likert scale after each operation as follows : 1= Dissection of the inferior mesenteric artery was standard 2 = Dissection of the inferior mesenteric artery was more complicated than expected 3 = Dissection of the inferior mesenteric artery was much more complicated than expected; 4 = Dissection of the inferior mesenteric artery was Very difficult.
Time frame: Week 3 to 4 on the day of rectal surgery
Systemic inflammation markers: Pro-inflammation cytokines
Pro-inflammation cytokines (IL-1β, IL-6, IL-8, Tumor Necrosis Factor-α and Interferon-ɣ) will be measured as percentages
Time frame: Day 0 (on the day of inclusion)
Systemic inflammation markers: Pro-inflammation cytokines
Pro-inflammation cytokines (IL-1β, IL-6, IL-8, Tumor Necrosis Factor-α and Interferon-ɣ) will be measured as percentages
Time frame: 25 minutes before embolization
Systemic inflammation markers: Pro-inflammation cytokines
Pro-inflammation cytokines (IL-1β, IL-6, IL-8, Tumor Necrosis Factor-α and Interferon-ɣ) will be measured as percentages
Time frame: 60 minutes after embolization
Systemic inflammation markers: Pro-inflammation cytokines
Pro-inflammation cytokines (IL-1β, IL-6, IL-8, Tumor Necrosis Factor-α and Interferon-ɣ) will be measured as percentages
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Systemic inflammation markers: Complement protein C3
Complement protein C3 will be measured as a percentage
Time frame: Day 0 (on the day of inclusion)
Systemic inflammation markers: Complement protein C3
Complement protein C3 will be measured as a percentage
Time frame: 25 minutes before embolization
Systemic inflammation markers: Complement protein C3
Complement protein C3 will be measured as a percentage
Time frame: 60 minutes after embolization
Systemic inflammation markers: Complement protein C3
Complement protein C3 will be measured as a percentage
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Anti-inflammation markers:
IL-10 and Transforming Growth Factor-β will be measured as percentages
Time frame: Day 0 (on the day of inclusion)
Anti-inflammation markers:
IL-10 and Transforming Growth Factor-β will be measured as percentages
Time frame: 25 minutes before embolization
Anti-inflammation markers:
IL-10 and Transforming Growth Factor-β will be measured as percentages
Time frame: 60 minutes after embolization
Anti-inflammation markers:
IL-10 and Transforming Growth Factor-β will be measured as percentages
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : Von Willebrand factor
Von Willebrand factor will be measured.
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : Von Willebrand factor
Von Willebrand factor will be measured.
Time frame: 25 minutes before embolization
Hemostasis markers : Von Willebrand factor
Von Willebrand factor will be measured.
Time frame: 60 minutes after embolization
Hemostasis markers : Von Willebrand factor
Von Willebrand factor will be measured.
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : coagulation factor V
Coagulation factor V will be measured.
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : coagulation factor V
Coagulation factor V will be measured.
Time frame: 25 minutes before embolization
Hemostasis markers : coagulation factor V
Coagulation factor V will be measured.
Time frame: 60 minutes after embolization
Hemostasis markers : coagulation factor V
Coagulation factor V will be measured.
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : D-dimers
D-dimers will be measured
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : D-dimers
D-dimers will be measured
Time frame: 25 minutes before embolization
Hemostasis markers : D-dimers
D-dimers will be measured
Time frame: 60 minutes after embolization
Hemostasis markers : D-dimers
D-dimers will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : platelet-activating factor (PAF)
Platelet-activating factor (PAF) will be measured
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : platelet-activating factor (PAF)
Platelet-activating factor (PAF) will be measured
Time frame: 25 minutes before embolization
Hemostasis markers : platelet-activating factor (PAF)
Platelet-activating factor (PAF) will be measured
Time frame: 60 minutes after embolization
Hemostasis markers : platelet-activating factor (PAF)
Platelet-activating factor (PAF) will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : prostaglandin E4
Prostaglandin E4 will be measured
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : prostaglandin E4
Prostaglandin E4 will be measured
Time frame: 25 minutes before embolization
Hemostasis markers : prostaglandin E4
Prostaglandin E4 will be measured
Time frame: 60 minutes after embolization
Hemostasis markers : prostaglandin E4
Prostaglandin E4 will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Hemostasis markers : Thromboxane B2
Thromboxane B2 will be measured.
Time frame: Day 0 (on the day of inclusion)
Hemostasis markers : Thromboxane B2
Thromboxane B2 will be measured.
Time frame: 25 minutes before embolization
Hemostasis markers : Thromboxane B2
Thromboxane B2 will be measured.
Time frame: 60 minutes after embolization
Hemostasis markers : Thromboxane B2
Thromboxane B2 will be measured.
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation: Blood pH
Blood pH will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation: Blood pH
Blood pH will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation: Blood pH
Blood pH will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation: Blood pH
Blood pH will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation: ischemia-modified albumin
Ischemia-modified albumin will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation: ischemia-modified albumin
Ischemia-modified albumin will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation: ischemia-modified albumin
Ischemia-modified albumin will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation: ischemia-modified albumin
Ischemia-modified albumin will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation:intestinal fatty acid-binding protein (I-FABP)
intestinal fatty acid-binding protein (I-FABP) will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation:intestinal fatty acid-binding protein (I-FABP)
intestinal fatty acid-binding protein (I-FABP) will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation:intestinal fatty acid-binding protein (I-FABP)
intestinal fatty acid-binding protein (I-FABP) will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation:intestinal fatty acid-binding protein (I-FABP)
intestinal fatty acid-binding protein (I-FABP) will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation: L-lactate
L-lactate will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation: L-lactate
L-lactate will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation: L-lactate
L-lactate will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation: L-lactate
L-lactate will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation: D-lactate
D-lactate will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation: D-lactate
D-lactate will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation: D-lactate
D-lactate will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation: D-lactate
D-lactate will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of tissue inflammation: Lactate dehydrogenase
Lactate dehydrogenase will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of tissue inflammation: Lactate dehydrogenase
Lactate dehydrogenase will be measured
Time frame: 25 minutes before embolization
Markers of tissue inflammation: Lactate dehydrogenase
Lactate dehydrogenase will be measured
Time frame: 60 minutes after embolization
Markers of tissue inflammation: Lactate dehydrogenase
Lactate dehydrogenase will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of neoangiogenesis : CD34
CD34 will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of neoangiogenesis : CD34
CD34 will be measured
Time frame: 25 minutes before embolization
Markers of neoangiogenesis : CD34
CD34 will be measured
Time frame: 60 minutes after embolization
Markers of neoangiogenesis : CD34
CD34 will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of neoangiogenesis : transcription factor HIF1-α
Transcription factor HIF1-α will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of neoangiogenesis : transcription factor HIF1-α
Transcription factor HIF1-α will be measured
Time frame: 25 minutes before embolization
Markers of neoangiogenesis : transcription factor HIF1-α
Transcription factor HIF1-α will be measured
Time frame: 60 minutes after embolization
Markers of neoangiogenesis : transcription factor HIF1-α
Transcription factor HIF1-α will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of neoangiogenesis : Growth factors
Growth factors and their receptors, notably vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor (FGF) and fibroblast growth factor receptor (FGFR) and platelet-derived growth factor (PDGF) and platelet-derived growth factor receptor (PDGFR) will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of neoangiogenesis : Growth factors
Growth factors and their receptors, notably vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor (FGF) and fibroblast growth factor receptor (FGFR) and platelet-derived growth factor (PDGF) and platelet-derived growth factor receptor (PDGFR) will be measured
Time frame: 25 minutes before embolization
Markers of neoangiogenesis : Growth factors
Growth factors and their receptors, notably vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor (FGF) and fibroblast growth factor receptor (FGFR) and platelet-derived growth factor (PDGF) and platelet-derived growth factor receptor (PDGFR) will be measured
Time frame: 60 minutes after embolization
Markers of neoangiogenesis : Growth factors
Growth factors and their receptors, notably vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor (FGF) and fibroblast growth factor receptor (FGFR) and platelet-derived growth factor (PDGF) and platelet-derived growth factor receptor (PDGFR) will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 2
Matrix metallo-protease - 2 will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 2
Matrix metallo-protease - 2 will be measured
Time frame: 25 minutes before embolization
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 2
Matrix metallo-protease - 2 will be measured
Time frame: 60 minutes after embolization
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 2
Matrix metallo-protease - 2 will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 9
Matrix metallo-protease - 9 will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 9
Matrix metallo-protease - 9 will be measured
Time frame: 25 minutes before embolization
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 9
Matrix metallo-protease - 9 will be measured
Time frame: 60 minutes after embolization
Markers of epithelial-mesenchymal transition : matrix metallo-protease - 9
Matrix metallo-protease - 9 will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
Markers of epithelial-mesenchymal transition : transcription factors
Transcription factors SNAI2 (SLUG), SNAI1 (SNAIL) and zinc-finger E-box binding homeobox (ZEB-1) will be measured
Time frame: Day 0 (on the day of inclusion)
Markers of epithelial-mesenchymal transition : transcription factors
Transcription factors SNAI2 (SLUG), SNAI1 (SNAIL) and zinc-finger E-box binding homeobox (ZEB-1) will be measured
Time frame: 25 minutes before embolization
Markers of epithelial-mesenchymal transition : transcription factors
Transcription factors SNAI2 (SLUG), SNAIL (SNAI1) and zinc-finger E-box binding homeobox (ZEB-1) will be measured
Time frame: 60 minutes after embolization
Markers of epithelial-mesenchymal transition : transcription factors
Transcription factors SNAI2 (SLUG), SNAIL (SNAI1) and zinc-finger E-box binding homeobox (ZEB-1) will be measured
Time frame: Week 3 to 4 after patient induction just before rectal surgery
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.