Rectal Cancer
Conditions
Keywords
laparotomy, laparoscopy, low anterior resection, rectal cancer, robot assisted surgery, total mesorectal excision, transanal surgery
Brief summary
Total mesorectal excision (TME) is the standard of care for rectal cancer, which can be combined with low anterior resection (LAR) in patients with mid-to-low rectal cancer. The narrow pelvic space and difficulties in obtaining adequate exposure make surgeries technically challenging. Four techniques are used to perform the surgery: open laparotomy, laparoscopy, robot-assisted surgery, and transanal surgery. Comparative data for these techniques is required to provide clinical data on the surgical management of rectal cancers by surgery.
Detailed description
The Rectal Surgery Evaluation Trial will be a prospective, observational, case-matched, four-cohort, multicenter trial designed to study TME with LAR using open laparotomy, laparoscopy, robot-assisted surgery, or transanal surgery in high-surgical-risk patients with mid-to-low, non-metastatic rectal cancer. All surgeries will be performed by surgeons experienced in a technique. Oncologic, morbidity and functional outcomes will be assessed in a composite primary outcome, with success defined as circumferential resection margin ≥1 mm, TME grade III, and minimal postoperative morbidity (absence of Clavien-Dindo grade III-IV complications within 30 days after surgery). Secondary endpoints will include the co-primary endpoints over the long-term (2 years), quality of surgery, quality of life, length of hospital stay, operative time, and rate of unplanned conversions.
Interventions
PROCEDURETME with LAR
Several surgical techniques are used to perform TME. Dissection using open laparotomy and minimally-invasive laparoscopic or robot-assisted abdominal approaches is performed in a 'top-down' manner, where the instruments are inserted transabdominally and the procedure progresses from splenic flexure/sigmoid colon mobilization to rectal resection. A transanal approach may also be used, a 'bottom-up' procedure where instruments are inserted through the anus to perform rectal resection and TME
Sponsors
Intuitive Surgical
Institut du Cancer de Montpellier - Val d'Aurelle
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years old 2. Rectal adenocarcinoma from middle and lower third (less than 10 cm from the anal verge) with a sphincter saving procedure 3. High risk operative patients (two of these factors as assessed on MRI): 1. Obese patient with a BMI \> 30 (male or female) 2. Narrow pelvis: inter-tuberous distance \< 10 cm 3. Large tumoral volume with suspicion of close predictive margin (CRM ≤ 1 mm) at diagnosis 4. Expected coloanal or ultra-low colorectal anastomosis 4. Patients with adequate performance status (Eastern Cooperative Oncology Group Scale score of ≤2) 5. Patient has signed and dated the informed consent before inclusion in the study.
Exclusion criteria
1. Patient with a comorbid illness or condition that would preclude the use of surgery. 2. Patients with T4b tumors which impose a pelvectomy 3. Patient requires an abdominal perineal resection (APR) 4. Patients with concurrent or previous invasive pelvic malignant tumors (cervical, uterine, or rectal; excluding the prostate) within 5 years before study enrollment 5. Patient undergoing emergency procedures 6. Planned rectal surgery along with major concomitant procedures (e.g. hepatectomies, other intestinal resections) 7. Metastatic disease 8. Pregnant or suspected pregnancy 9. Patients unwilling to comply with all follow-up study requirements 10. Patient included in another study which impact on the surgical technique or its choice.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of surgical method (success determined by composite of Oncologic, morbidity and functional outcomes) | up to 4 years | CRM, TME grade III, The absence of clavien dindo grade III-IV complications within 30 days post op |
Countries
France
Outcome results
None listed