Adenocarcinoma of the Colon
Conditions
Keywords
Adenocarcinoma in right colon, mCME, oncologic outcomes, right-sided colon cancer
Brief summary
This study is a multi-institutional, prospective, observational study evaluation oncologic outcomes of laparoscopic modified complete mesocolic excision (mCME) on right-sided colon cancer. The primary outcome of this study is 3 year disease-free survival. Secondary outcome measures include 3 year overall survival, incidence of surgical complications, completeness of mCME, and distribution of metastatic lymph nodes.
Detailed description
The present study aims to evaluate the oncological outcomes of laparoscopic mCME on right-sided colon cancer. The right side of the colon was defined as the colon from cecum up to the proximal half of the transverse colon. The number of patients needs to get a 90% power is 250. Patients will be enrolled at five leading centers in South Korea. A complete information leaflet will give to the patients during the first consultation, which will correspond to the enrollment day. The preoperative, intraoperative, and postoperative period will be in complete accordance with the usual care of the center. The baseline demographics and conditions, as well as the perioperative items and the postoperative occurrences, will be recorded through a prior designed case report form. The follow-up encompasses 13 postoperative consultations: 1month, 3 months, after that every 3 months until 36 months. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, the incidence of surgical complications, completeness of mCME, and distribution of metastatic lymph nodes. Review of resected surgical specimens and the operative field after completion of lymph node dissection will be done based on photographs to assess the quality if surgery.
Interventions
PROCEDURELaparoscopic modified complete mesocolic excision
First, complete kocherization may be required to clear possible tumor spread if the tumor is infiltrating or adhering to the duodenum or perinephric fat tissue. Second, if the tumor is locally advanced, the entire prerenal soft tissue behind Gerota's fascia may need to be cleared, especially for tumors growing toward the posterior. The third difference of mCME with the conventional CME involves the tailored resection of the mesocolon and ileal mesentery according to tumor location. After identifying the root of the middle colic artery, the site of the vascular ligation depends on the location of the tumor. When the tumor is located in the cecum and ascending colon, only the right branch of the middle colic artery is ligated. If the tumor was present in these latter sites, the root of the middle colic artery is ligated.
Sponsors
Yonsei University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 1\. Qualitative diagnosis: a pathological diagnosis of adenocarcinoma; the tumor located between the cecum and the right 1/2 of transverse colon * 2\. Patients suitable for curative surgery older than 19 years old * 3\. ASA grade I-III * 4\. Patients without preoperative treatment * 5\. Informed consent
Exclusion criteria
* 1\. Informed consent refusal * 2\. Patients who need emergency operation; such as perforation, malignant colonic obstruction * 3\. Preoperative imaging examination results show: distant metastasis * 4\. Hereditary colon cancer * 5\. History of any other malignant tumor in recent 5 years, except for cervical carcinoma in situ which has been cured, basal cell carcinoma or squamous cell carcinoma of skin; * 6\. Simultaneous or simultaneous multiple primary colorectal cancer * 7\. Women during Pregnancy or breast feeding period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 3 year disease-free survival (DFS) | DFS will be measured up to three years after surgery, and the last visit is 14th visit after index surgery. | The 3 year disease-free survival is defined as the time from surgery until documented recurrence or death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 3 year overall survival (OS) | Three years after surgery | The time from surgery until documented death from any cause |
| Incidence of surgical complications | Until four weeks after surgery | — |
| Completeness of mCME | Two weeks after surgery | A. By reviewing resected surgical specimens based on photographs B. By reviewing the operative field after lymph node dissection and specimen removal based on photographs |
| Distribution of metastatic LNs | Two weeks after surgery | Lymph nodes retrieved from resected surgical specimens to categorise |
Countries
South Korea
Outcome results
None listed