Safe D3 Right Hemicolectomy for Cancer Through Multidetector Computed Tomography (MDCT) Angio

Overview

When performing a resection of the right colon due to cancer one aims not only to remove the tumor bearing bowel segment, but also lymph nodes draining the affected area. These lymph nodes are located along the arteries supplying the right colon. Through using a preoperative CT scan which can map these arteries very precisely one can ligate these vessels closer to their origin and thus remove more lymph nodes which may potentially harbor cancer cells. This study aims to compare patients operated more radically through use of preoperative CT which maps the mentioned arteries with patients operated in the standard way.

Full Title of Study: “Safe D3 Right Hemicolectomy for Cancer Through 3D MDCT Angiography Reconstruction”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 2021

Detailed Description

The Norwegian gastrointestinal cancer group has recommended D3 resection as the standard operative technique for colon cancer. D3 resection implies ligation of the blood vessels at their origin. There is evidence that the recurrence free period and survival improves with the number of lymph nodes harvested at surgery. However, the current practice in Norway, while performing right hemicolectomy for cancer is to ligate the feeding vessels for the right colon on the right hand side of the superior mesenteric vein (SMV). Significant arterial stumps have been demonstrated in patients operated for right colon cancer with this technique (right colic artery and ileocolic artery vascular stumps with an average length of 3.5 cm and 2.5 cm, respectively). This leaves reason to believe that a certain number of central lymph nodes remain after the procedure. The complex anatomical relationship between the right colic artery and ileocolic artery with the superior mesenteric vein make D3 resection demanding, especially if the right colic artery lies posterior to the SMV. These relationships are investigated in detail in postmortem anatomical studies. These studies show that the right colic artery lies most often anterior to the SMV, while the ileocolic artery lies most often posterior to the SMV. Data has also been provided that a CT angiography can verify these relations as well as postmortem anatomical studies in living patients, thus allowing the surgeon to be aware of them prior to surgery. This could prove to be crucial in planning the procedure.

Interventions

  • Procedure: D3 resection
    • Radical D3 resection of the right colon through the use of preoperative MDCT angiography

Arms, Groups and Cohorts

  • Other: D3 resection
    • Radical D3 resection of the right colon through the use of preoperative MDCT angiography

Clinical Trial Outcome Measures

Primary Measures

  • Number of additional lymph nodes removed through radical D3 resection
    • Time Frame: 1 year
    • The short term outcome of this study will compare number of lymph nodes removed, operating time and complications between the two groups.

Secondary Measures

  • Disease free survival 2 and 5 years after initial surgery
    • Time Frame: 5 years
    • One will compare disease free survival at 2 and 5 years between the two groups to see if those more radically operated through D3 resection will have better outcomes.

Participating in This Clinical Trial

Inclusion Criteria

  • Patients with histo-pathologically verified adeno-carcinoma of the right colon – Patients under the age of 75 – Patients medically cleared by anesthesiologist for general anesthesia – Signed informed consent form Exclusion Criteria:
  • Patients with recurrent cancer after previous surgery – Patients with distant metastasis – Patients who are not medically cleared to undergo anesthesia – Patients who do not sign the informed consent form
  • Gender Eligibility: All

    Minimum Age: 20 Years

    Maximum Age: 75 Years

    Are Healthy Volunteers Accepted: No

    Investigator Details

    • Lead Sponsor
      • Sykehuset i Vestfold HF
    • Collaborator
      • Konya Training and Research Hospital
    • Provider of Information About this Clinical Study
      • Principal Investigator: Dejan Ignjatovic, MD, PhD, Professor – University Hospital, Akershus
    • Overall Contact(s)
      • Dejan Ignjatovic, MD, PhD, +4746681797, dexexer01@hotmail.com

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