Inflammation After Laparoscopic Robot-assisted Surgery for Locally Advanced Rectal Cancer
Condition: Locally Advanced Rectal Cancer; Abdominoperineal Resection
MeSH terms: Rectal Neoplasms; Inflammation
Study type: Observational

Summary: 
      The intention of the study is to explore metabolic and inflammatory parameters in the pelvis
      and systemically after abdominoperineal resection (APR) for locally advanced rectal cancer
      (LARC) in patients that have received radiation therapy before surgery. In this study the
      inflammatory response after laparoscopic robot-assisted APR for LARC will be compared to
      results obtained in a recent cohort of patients operated with open APR for LARC, which will
      serve as the control population.
    

Detailed description: 
      Locally advanced rectal cancers (LARC) threaten the normal surgical margins and therefore
      needs neoadjuvant (chemo-) radiotherapy to down-stage the tumor before surgery. The Norwegian
      Radium Hospital Oslo University Hospital is a regional center for treatment of LARC in the
      south-eastern part of Norway and treat approximately 80-100 patients in this category
      annually. About 50 of these patients receive abdominoperineal resection (APR) as the main
      surgical treatment.

      Laparoscopic surgery in LARC has been limited because of difficult dissection with straight
      instruments outside the normal anatomical planes in the confined space of the pelvis.
      However, recent papers report on better feasibility and good results in robot-assisted
      surgery for LARC. In respect to shorter postoperative length of stay for minimally invasive
      compared to open surgery, reduced inflammation may be the explanation, however, results are
      not conclusive. Most studies comparing open to minimally invasive surgery in colorectal
      cancer have had conventional laparoscopy as the minimally invasive group, including studies
      comparing inflammation after surgery. A study on inflammation after laparoscopic
      robot-assisted major surgery for bladder cancer has recently been published, but to our
      knowledge no comprehensive studies have been done with patients with rectal cancer
      resections. Additionally, there are claims that excessive and/or dysregulated inflammatory
      response after cancer surgery, worsen oncologic outcome. The need to characterize the
      inflammatory response after laparoscopic robot-assisted surgery of rectal cancer is thus
      highly relevant and needed.

      The investigators want to analyse inflammatory parameters in plasma and peritoneal fluid in
      patients undergoing robot-assisted and open surgery for LARC.

      Microdialysis is a technique which enables close to real-time monitoring of the tissues and
      organs of interest. The investigators want to utilize the microdialysis method to describe
      and monitor metabolic and inflammatory parameters in some patients after extensive
      robot-assisted oncological surgery for LARC.

      The investigators hypothesize inflammatory response differ between patients undergoing open
      versus robot-assisted surgery.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with locally advanced rectal cancer who receive radiotherapy >25 Gy prior to
        surgery.
      
Biospecimen description: 
      Peritoneal fluid - daily samples as long as a pelvic drain is indicated. Regularly standard
      blood samples. Daily EDTA-plasma until post operative day 4, or longer if clinically
      indicated.
    
Keywords: Microdialysis; Inflammatory Response