Abdominoperineal Resection, Parastomal Hernia, Rectal Adenocarcinoma
Conditions
Brief summary
Chimney trial is designed to compare the effectiveness and safety of specifically designated polyvinylidene fluoride mesh (PVDF, Dynamesh IPST) to controls in a multi center, randomized setting.
Detailed description
The European Hernia Society recommends the use of prophylactic mesh when permanent colostomy is made. The results of previous trials using keyhole technique are partially unsatisfactory. Specifically designed PVDF mesh used in this trial showed promising results in previous small trial. Chimney trial is designed to compare the effectiveness and safety of mesh group to controls operated with no preventive mesh in parastomal hernia prevention after laparoscopic or robotic-assisted abdominoperineal resection or low Haartman's procedure for rectal adenocarcinoma.
Interventions
DEVICEIntervention group
Polyvinylidene fluoride mesh (Dynamesh IPST) is used on intraperitoneal onlay position to prevent parastomal hernia.
Sponsors
University of Oulu
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
Participants are unaware of the randomization group.
Intervention model description
Chimney trial is a prospective randomized controlled multicenter trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years or older * Rectal adenocarcinoma with curative intent laparoscopic or robotic assisted abdominoperineal resection or low Hartmann´s operation and permanent colostomy * Patient has a life expectancy of at least 12 months. * Patient must sign Informed consent before any study procedures and agrees to attend all study visits
Exclusion criteria
* Abdominoperineal resection or Hartmann's operation by laparotomy or conversion to laparotomy * Complication requiring laparotomy during post surgery treatment at surgical ward after APR * Patient with a comorbid illness or condition that would preclude the use of surgery (ASA 4-5). * Patients with concurrent or previous malignant tumors within 5 years before study enrollment * Patients with T4b tumors which impose a multi-organ resection * Rectal malignancy other than adenocarcinoma * Patient undergoing emergency procedures * Planned rectal surgery along with major concomitant procedures (e.g. hepatectomies, other intestinal resections). * Metastatic disease with no possibility of curative surgery * Pregnant or suspected pregnancy * Patients living geographically distant and/or unwilling to return for follow-ups or comply with all study requirements * Active abdominal infection at the time of surgery * Previous surgery at the colostomy site * Language barrier or other reasons why informed consent is not possible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of parastomal hernia | 12 months | Incidence of parastomal hernia at 12 months follow up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Surgical site infection rate | 30 days | Surgical site infections measured by Clavien-Dindo Classification |
| Complications | 30 days | Complications measured by Clavien-Dindo Classification |
| Stoma related complications | 5 years | Stoma related complications measured by Clavien-Dindo Classification |
| Reoperation rate | 5 years | Need for reoperations |
| Operative time | 1 day | Operative time |
| Incidence of parastomal hernia at long term follow up | 5 years | Incidence of parastomal hernia during 5 years of follow up |
| Rand 36 quality of life | 5 years | Quality of life measured by Rand-36 quality of life questionnaire |
| Quality of life measured by Colostomy impact score | 5 years | Quality of life measured by Colostomy impact score |
| Medico-economic substudy | 5 years | Medico-economic substudy including both short and long term costs included in both groups |
| Radiological substudy of stoma distance | 3 years | Distance of stoma from midline defined by umbilicus |
| Radiological substudy of adipose tissue thickness | 3 years | Thickness of adipose tissue on computer tomography scan on contralateral site of stoma |
| Length of stay | 30 days | Length of stay at the hospital |
Countries
Finland, Sweden
Outcome results
None listed