Adhesions After Open Versus Laparoscopic Resection of Colorectal Malignancies Detected During Liver Resection
- Conditions
- Adhesions
- Interventions
- Procedure: Liver resection
- Registration Number
- NCT01720966
- Lead Sponsor
- Radboud University Medical Center
- Brief Summary
Rationale: Adhesion formation is a frequent complication after abdominal surgery. Adhesion formation might be reduced by laparoscopic surgery, however sound evidence is lacking. Colorectal surgery would be a good clinical model to investigate adhesion formation between open and laparoscopic surgery because of the adhesion formation propensity of colorectal surgery. However, a randomized controlled study to provide direct evidence is unlikely because of large numbers of patients needed for such a trial and the difficulty to check for adhesion formation at second surgery. Therefore we investigate adhesion formation after laparoscopic and open colorectal surgery for malignancy at liver surgery for metastases.
Objective: The aim of our study is to compare the incidence of adhesions after laparoscopic versus open surgery for colorectal malignancies during liver resection for colorectal metastases.
Study design: The study is designed as a prospective observational cohort study.
Study population: All consecutive, adult patients undergoing laparotomy or laparoscopy for intended liver resection or radio frequency ablation for liver metastases of a colorectal malignancy in whom inspection of the middle and lower abdomen is possible to map adhesions.
Main study parameters/endpoints:
* Primary endpoint is incidence of adhesions to the ventral abdominal wall around the site of the original incision.
* Secondary endpoints are episodes of bowel obstruction between index surgery and liver surgery; total incidence of adhesions; extent of adhesions; Zühlke classification of adhesions; performance of adhesiolysis; duration of adhesiolysis; peroperative complications: enterotomy, seromuscular injury, inadvertent organ injury during adhesiolysis; postoperative complications: delayed diagnosed perforation, SAE's.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: This study is an observational study. The existence of adhesions will be assessed during laparotomy or laparoscopy for the treatment of liver metastases. The laparotomy is indicated for medical treatment and should not be enlarged solely for the assessment of adhesions nor will the operating time be influenced for this purpose.
Adhesions and peroperative complications have to be scored by the operating surgeon during or directly after surgery. The postoperative complications have to be scored during the postoperative course by the doctors on the ward. These assessments do not interfere with the treatment of the patients.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 150
- laparotomy or laparoscopy for intended liver resection or radio frequency ablation for colorectal metastases
- laparoscopy or laparotomy for colorectal malignancy in history
- age ≥18 years
-
a history of abdominal surgery with a high risk of adhesions either before resection of the primary tumour or during the interval between resection of the primary tumour and liver resection. These high risk surgeries are:
- Colorectal surgery
- Ovarian surgery
- Abdominal wall surgery
-
mental incompetence
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Laparoscopy Liver resection Patients who will undergo liver resection who have a laparoscopically performed colorectal resection in history. Assignment to cohort is on intention to treat of the primary operation. Laparotomy Liver resection Patients who will undergo liver resection who have an open colorectal resection in history. Assignment to cohort is on intention to treat of the primary operation.
- Primary Outcome Measures
Name Time Method Incidence of adhesion to ventral abdominal wall peroperative (1 day) To compare the incidence of adhesions to the ventral abdominal wall in patients undergoing laparotomy or laparoscopy for intended liver resection for colorectal metastases after open versus laparoscopic resection of the primary tumour.
- Secondary Outcome Measures
Name Time Method Adhesion Score peroperative (1 day) Adhesion score according to Zühlke
Incidence of adhesions peroperative (1 day) Total incidence of adhesions
Adhesiolysis peroperative (1 day) need to perform adhesiolysis
Inadvertent bowel injury peroperative (1 day) Inadvertent bowel injury made during operation
Extent of adhesions peroperative (1 day) Extent of adhesions
Duration of adhesiolysis peroperative (1 day) Duration of adhesiolysis in minutes
Postoperative mobidity 30 days Incidence of predetermined postoperative complications:
* mortality
* incisional wound infection
* abdominal sepsis
* pneumonia
* urinary tract infection
Trial Locations
- Locations (6)
Gelre Ziekenhuis
🇳🇱Apeldoorn, Netherlands
Ziekenhuis Gelderse Vallei
🇳🇱Ede, Netherlands
Maxima Medisch Centrum
🇳🇱Veldhoven, Netherlands
Maastricht University Medical Center
🇳🇱Maastricht, Netherlands
Radboud University Nijmegen Medical Center
🇳🇱Nijmegen, Gelderland, Netherlands
Daniel de hoed kliniek
🇳🇱Rotterdam, Netherlands