Right Colectomy for Colon Cancer Database

Right colectomy for colon cancer database

1. Scientific plan: 1.1. Rationale for the project Colon cancer is the third most cancer in Norway. Five-year relative survival for men and women is 65% and 69% respectively. Surgery is the cornerstone of the treatment and about 50% of patients are cured by surgery alone. In 2018, 2117 patients with stage I-III colon cancer were operated in Norway. About half of them with right-sided colectomies. Parallel to the development of minimally invasive surgery, focus on more radical surgical technique has been increasing, inspired by the improved survival in rectal cancer. Despite growing interest in surgical technique, the level of evidence in this area is low. Reasons are the lack of a common definitions of surgical technique and anatomical differences between the right and left colon. There are two sets of terms used to describe radical colon cancer surgery with adequate lymph node harvest and dissection along embryological planes. The Japanese D2 and D3 dissection refers to lymph node stations and the corresponding European "complete mesocolic excision" (CME) and central vascular ligation (CVL) to anatomical planes. Despite the mentioned uncertainties, there is growing evidence that more radical surgery is leading to improved oncological outcome in right- sided colon cancer. Minimal invasive surgery improves quality of life by reducing pain, postoperative complications and thereby reduces hospital stay and convalescence, but there is concern that more radical surgery is associated with more intraoperative injuries and severe non-surgical complications than "conventional" resection for colon cancer. Robotic assisted right-sided colectomy could overcome the technical challenges of more radical surgery with all benefits from minimal invasive surgery. Introduction of new health technologies may cause serious harm to patients and has to be monitored carefully. In Norway, reporting to the Norwegian Cancer Registry and the Norwegian Registry for Gastrointestinal Surgery is mandatory. But both registries do not cover details of the surgical technique, route of access and quality of the specimen.

1.2. Participating institutions and database solution To date, the applicants have several databases approved by the local ethics committee that cover different topics of colorectal cancer. In order to make the database accessible to a larger cohort we decided to create a web-based solution. From the existing databases, a selection of a maximum of 50 parameters have to be transferred.

The database will be designed as an easy to use, cloud-based solution which enables multiuser and multicenter utility. The database will have filters and include tools for analysis and statistics to facilitate generation of descriptive data to be used for data quality assurance and hypotheses testing. This function will also provide regular reports (i.e. every 6 months) to ensure data quality and patient safety during the introduction of more radical surgery and throughout the study. The web-access functionality of the database went through a risk and vulnerability analysis of the local health care authorities and is approved by "Helse Vest IKT". It will also have the possibility to include patient outcome measures (PROMS) and patient reported experience (PREMS) modules. In order to reach statistical power for some hypothesis (i.e. oncological outcome) we will need a sample size that is too big for a single institution. Therefore, the database will be offered to all Norwegian hospitals operating right-sided colectomies.

1.3. Data collection To have a valid control group, all operations for right-sided colon cancer will be registered, including open, laparoscopic and robotic assisted access. The extend of surgery will be documented according to the Japanese D2 and D3 classification, as D2-, complete D2- and D3 dissection. The quality of the specimen will be assessed by the operating surgeon and pathologist by a newly proposed classification system for right-sided colon cancer. Photo documentation of the anatomy after dissection will give the opportunity to analyse the quality of surgery independently. All data will be recorded prospectively immediately after the operation and after 30 days. Long-term outcomes such as survival, hernia, and recurrences shall be checked 6 monthly. In addition, in order to avoid double data entry oncological results will be collected from the Norwegian Cancer Registry and postoperative complications from the Norwegian Registry for Gastrointestinal Surgery. Merging data from national databases is current practice in Norway and there will be no delay. Ethical committee has approved the study. The patients will be asked for informed consent before data collection. Data can be collected in the web-based database Ledidi (Intraoperative, postoperative form) or paper based. Participating other hospitals will get access to the database after signing a collaboration and data processor agreement.