Italian Study on the Right Hemicolectomy: How the Lymphadenectomy is Performed
Condition: Colon Cancer; Lymph Node Metastasis; Surgical Procedure, Unspecified
MeSH terms: Colonic Neoplasms; Lymphatic Metastasis
Study type: Observational

Summary: 
      The objective of the study is the analysis of lymphadenectomy in the course of right
      hemicolectomy, in relation to the radicality of the surgical resection that is performed. In
      particular, the investigators wants to inquire how according to precise standards regarding
      surgical radicalness and consequently the anatomical piece that is obtained it is possible to
      correlate a certain number of lymph nodes and their possible positivity.

      The lead center is the General and Thoracic Surgery Department of the University of Ferrara.
      Prof. Anania is the responsible for the enrollment of patients and the coordination with the
      collaborating centers in the six month-study
    

Detailed description: 
      All the high-volume specialist centres that perform this type of intervention in Italy will
      be invited, with a minimum number of 25 interventions per year. At the end of the study 788
      patients was enrolled.

      The data of the patients involved will be collected independently and anonymously by the
      individual centers involved, using a common alpha numeric code decided by the coordinating
      center.

      The parameters examined will be:

        -  Personal data of the patient

        -  Stage of neoplasm due to surgery

        -  Type of surgery and duration

        -  Post-operative course

        -  Presence of post-surgical complications and eventual hospital readmission due to these
           complications

        -  Study of the operating piece and lymphadenectomy performed:

      Tumor free margin Terminal ilium length The different vascular ligatures and levels at which
      they are performed Integrity of the mesocolon Number of positive nodes per total removed

      Following the end of the 6 months of observational study period, the data will be processed
      anonymously at the coordinating centre.
    

Intervention name(s): Right hemicolectomy
Intervention type(s): Procedure
Intervention description(s): It begins with a thorough laparoscopic inspection of the abdomen for evidence of metastatic disease and to confirm the location of the tumor. Usually is performed dissection using a medial-to-lateral approach. A lateral or inferior approach can also be used depending on the anatomy. The vascular dissection may begin at the ileocolic pedicle or over the superiore mesenteric vein. After completing the medial-to-lateral dissection, the sourgeons return to the ileocolic pedicle to begin vascular dissection. Whether a D2 (until encountering the right branch of the middle colic) or D3 dissection (until the root of ileocolic artery and vein) is performed depends upon the tumor stage. For an intracorporeal anastomosis, the bowel is transected proximally and distally using a linear stapler. The terminal ileum is positioned along the transverse colon in an isoperistaltic fashion. After that a colotomy and an enterotomy are made on the antimesenteric edge of the colon and small bowel respectively
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients aged > 18, men and women, operated by laparoscopic/robotic or video-assisted right
        hemicolectomy, under election regime with diagnosis of colic adenocarcinoma in one of the
        centers that take part of the study After the 6 months period a total of 788 patients was
        enrolled in the 76 italian centers
      
Keywords: Right hemicolectomy; Colon cancer; Lymphadenectomy