Reconstruction Techniques and Vascular Approach After Laparoscopic Left Hemicolectomy and Rectum Low Anterior Resection
- Conditions
- Colorectal CancerRectal Tumors
- Interventions
- Procedure: Initially dissection of inferior mesenteric veinProcedure: Initially dissection of inferior mesenteric arteryProcedure: Latero-terminal colorectal anastomosisProcedure: Termino-terminal colorectal anastomosis
- Registration Number
- NCT02746224
- Lead Sponsor
- Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta
- Brief Summary
This is an interventional, controlled and randomized single-center clinical trial with patients diagnosed with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer.
All patients included in the study (study 1) are randomized into two groups (group 1A and group 1B): in the group 1A the surgical technique initially dissects the inferior mesenteric vein (IMV) and in the group 1B the surgical technique initially dissects the inferior mesenteric artery.
The patients who will undergo a colorectal anastomosis will be included in the study 2 and will be randomized to group 2A and group 2B: in group 2A the patients will have a latero-terminal colorectal anastomosis and in group 2B a termino-terminal colorectal anastomosis.
Study hypothesis:
Study 1: the surgical technique that initially dissects the IMV presents a greater number of total resected lymph nodes compared to the technique that initially dissects the IMA.
Study 2: latero-terminal anorectal anastomosis has a better anorectal functional outcome than termino-terminal anorectal anastomosis.
Primary outcome measures:
* Study 1:To compare the total number of resected lymph nodes and the distance to the surgical margins between the two arms (1A and 1B).
* Study 2: to compare the anorectal functional outcome at 12 months after surgery or ileostomy closure between the two arms (2A and 2B). The anorectal function will be assessed by the scores of the validated Colorectal Functional Outcome Questionnaire (COREFO) and the validated scale LARS (Syndrome anterior resection of the rectum).
Secondary outcome measures:
* Study 1: to compare the duration of surgery, bleeding and need for surgical conversion between the two arms (1A and 1B). Another objectives are to compare the incidence of postoperative complications (measured by the Clavien-Dindo classification) and survival.
* Study 2: to compare the quality of life and anorectal functional outcomes at : 6, 12, 18 and 24 months after intervention (or ileostomy closure) between the two arms (2A and 2B). The anorectal function will be assessed by the validated COREFO questionnaire and the LARS scale. The quality of life will be assessed by the validated questionnaire of quality of life: SF-36. Another objective is to compare the incidence of postoperative complications assessed by the Clavien-Dindo classification and the incidence of anastomotic leakage.
- Detailed Description
This is an interventional, controlled and randomized single-center clinical trial with patients diagnosed with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer.
Methods:
All patients included in the study (study 1) are randomized into two groups (group 1A and group 1B): in the group 1A the surgical technique initially dissects the inferior mesenteric vein (IMV) and in the group 1B the surgical technique initially dissects the inferior mesenteric artery.
The patients who will undergo a colorectal anastomosis will be included in the study 2 and will be randomized to group 2A and group 2B: in group 2A the patients will have a latero-terminal colorectal anastomosis and in group 2B a termino-terminal colorectal anastomosis.
Study hypothesis:
Study 1: the surgical technique that initially dissects the IMV presents a greater number of total resected lymph nodes compared to the technique that initially dissects the IMA.
Study 2: latero-terminal anorectal anastomosis has a better anorectal functional outcome than termino-terminal anorectal anastomosis.
Primary outcome measures:
* Study 1:To compare the total number of resected lymph nodes and the distance to the surgical margins between the two arms (1A and 1B).
* Study 2: to compare the anorectal functional outcome at 12 months after surgery or ileostomy closure between the two arms (2A and 2B). The anorectal function will be assessed by the scores of the validated Colorectal Functional Outcome Questionnaire (COREFO) and the validated scale LARS (Syndrome anterior resection of the rectum).
Secondary outcome measures:
* Study 1: to compare the duration of surgery, bleeding and need for surgical conversion between the two arms (1A and 1B). Another objectives are to compare the incidence of postoperative complications (measured by the Clavien-Dindo classification) and survival.
* Study 2: to compare the quality of life and anorectal functional outcomes at : 6, 12, 18 and 24 months after intervention (or ileostomy closure) between the two arms (2A and 2B). The anorectal function will be assessed by the validated COREFO questionnaire and the LARS scale. The quality of life will be assessed by the validated questionnaire of quality of life: SF-36. Another objective is to compare the incidence of postoperative complications assessed by the Clavien-Dindo classification and the incidence of anastomotic leakage.
Duration and follow up
Study 1: the expected study duration is 6'5 years.
Study 2: the expected duration of the study is 3'5 years.
The planned duration of follow up in the study 1 is 5 years, in the study 2 is 2 years.
Selection criteria
Inclusion Criteria:
Study 1:
* Patients with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer.
* Age ≥ 18 years
* Histology proven adenocarcinoma or adenoma with or without chemotherapy or neoadjuvant radiochemotherapy
* Any T, any N, M or any adenoma
* Attempt to R0 resection
* Signed informed consent by the patient and by the researcher
* Quality of Life Questionnaire completed
Study 2:
* Patients with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer with colorectal anastomosis.
* Age ≥ 18 years
* Histology proven adenocarcinoma or adenoma with or without chemotherapy or neoadjuvant radiochemotherapy
* Any T, any N, M or any adenoma
* Attempt to R0 resection
* Signed informed consent by the patient and by the researcher
* Quality of Life Questionnaire completed
Exclusion Criteria:
Study 1:
* Colorectal tumor with different histology to adenocarcinoma or adenoma
* History of colorectal cancer surgery different to the local excision
* Inflammatory bowel disease with pathologic confirmation
* Patients with psychiatric illness, addiction or disorder with inability to understand informed consent
* Inability to read or understand any of the languages of the informed consent and questionnaires (Catalan, spanish)
* Another synchronous malignancy
* Emergency Surgery
* Any patient that medical characteristics present an individual risk raised to be included and complete the study
Study 2:
* Patients who won't undergo colorectal anastomosis
* Colorectal tumor with different histology to adenocarcinoma or adenoma
* History of colorectal cancer surgery different to the local excision
* Inflammatory bowel disease with pathologic confirmation
* Patients with psychiatric illness, addiction or disorder with inability to understand informed consent
* Inability to read or understand any of the languages of the informed consent and questionnaires (Catalan, spanish)
* Another synchronous malignancy
* Emergency Surgery
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 64
Study 1:
- Patients with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer.
- Age ≥ 18 years
- Histology proven adenocarcinoma or adenoma with or without chemotherapy or neoadjuvant radiochemotherapy
- Any T, any N, M or any adenoma
- Attempt to R0 resection
- Signed informed consent by the patient and by the researcher
- Quality of Life Questionnaire completed
Study 2:
- Patients with colorectal cancer that will undergo laparoscopic left hemicolectomy or laparoscopic low anterior resection for rectal cancer with colorectal anastomosis.
- Age ≥ 18 years
- Histology proven adenocarcinoma or adenoma with or without chemotherapy or neoadjuvant radiochemotherapy
- Any T, any N, M or any adenoma
- Attempt to R0 resection
- Signed informed consent by the patient and by the researcher
- Quality of Life Questionnaire completed
Study 1:
- Colorectal tumor with different histology to adenocarcinoma or adenoma
- History of colorectal cancer surgery different to the local excision
- Inflammatory bowel disease with pathologic confirmation
- Patients with psychiatric illness, addiction or disorder with inability to understand informed consent
- Inability to read or understand any of the languages of the informed consent and questionnaires (Catalan, spanish)
- Another synchronous malignancy
- Emergency Surgery
- Any patient that medical characteristics present an individual risk raised to be included and complete the study
Study 2:
- Patients who won't undergo colorectal anastomosis
- Colorectal tumor with different histology to adenocarcinoma or adenoma
- History of colorectal cancer surgery different to the local excision
- Inflammatory bowel disease with pathologic confirmation
- Patients with psychiatric illness, addiction or disorder with inability to understand informed consent
- Inability to read or understand any of the languages of the informed consent and questionnaires (Catalan, spanish)
- Another synchronous malignancy
- Emergency Surgery
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description group 1A Initially dissection of inferior mesenteric vein the surgical technique initially dissects the inferior mesenteric vein (IMV). group 2A Latero-terminal colorectal anastomosis the patients will have a latero-terminal colorectal anastomosis group 2B Termino-terminal colorectal anastomosis the patients will have a termino-terminal colorectal anastomosis. group 1B Initially dissection of inferior mesenteric artery the surgical technique initially dissects the inferior mesenteric artery (IMA). group 2B Initially dissection of inferior mesenteric artery the patients will have a termino-terminal colorectal anastomosis. group 2A Initially dissection of inferior mesenteric vein the patients will have a latero-terminal colorectal anastomosis
- Primary Outcome Measures
Name Time Method Anorectal functional outcome at 12 months assessed by LARS scale 12 months Study 2: to compare the anorectal functional outcome at 12 months after surgery or ileostomy closure between the two arms (2A and 2B). Assessed by the validated scale LARS (Syndrome anterior resection of the rectum).
Total number of resected lymph nodes 1 month Study 1:To compare the total number of resected lymph nodes between the two arms (1A and 1B).
Anorectal functional outcome at 12 months assessed by COREFO questionnaire 12 months Study 2: to compare the anorectal functional outcome at 12 months after surgery or ileostomy closure between the two arms (2A and 2B). Assessed by the validated Colorectal Functional Outcome Questionnaire (COREFO)
- Secondary Outcome Measures
Name Time Method Intraoperative outcomes: duration of surgery 1 day Study 1: to compare the duration of surgery measured in minutes between the two arms (1A and 1B).
Anorectal functional outcome assessed by LARS scale 6,18 and 24 months after surgery to compare the anorectal functional outcomes at : 6, 18 and 24 months after intervention (or ileostomy closure) between the two arms (2A and 2B). Assessed by the validated scale LARS (Syndrome anterior resection of the rectum).
Intraoperative outcomes: surgical conversion 1 day Study 1: to compare the incidence of surgical conversion to laparotomy between the two arms (1A and 1B).
Postoperative complications 90 days Study 1 and 2: Postoperative complications within 90 days after surgery (Clavien-Dindo classification).
Intraoperative outcomes: surgical bleeding 1 day Study 1: to compare the surgical bleeding measured in ml between the two arms (1A and 1B).
Quality of life-SF questionnaire 6, 12, 18 and 24 months after surgery Study 2: to compare the quality of life : 6, 12, 18 and 24 months after intervention (or ileostomy closure) between the two arms (2A and 2B). Assessed by the validated the validated questionnaire of quality of life: SF-36.
Survival 5 years Study 1: 5-year survival rate after surgery
Postoperative complications and anastomotic leakage 90 days after surgery Study 2: to compare the incidence of postoperative complications assessed by the Clavien-Dindo classification and the incidence of anastomotic leakage according to the classification of the International Group for Rectal Cancer Study.
Anorectal functional outcome assessed by COREFO questionnaire 6,18 and 24 months after surgery Study 2: to compare the anorectal functional outcomes at : 6, 18 and 24 months after intervention (or ileostomy closure) between the two arms (2A and 2B). Assessed by the validated Colorectal Functional Outcome Questionnaire (COREFO).
Distance to surgical margins 1 month Study 1: To compare distance to surgical margins measured in mm between the group 1A and 1B
Trial Locations
- Locations (1)
University Hospital Dr. Josep Trueta of Girona
🇪🇸Girona, Spain