Radiologic Assessment in Complete Mesocolic Excision for Right Colon Cancer (RACOMERC)

Study Overview
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Brief Summary
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Colorectal surgery has made progressive advances in recent years related on one hand to the implementation of diagnostic methods that allow an early diagnosis of tumors and on the other hand to the development of therapeutic options based on laparoscopic surgery. In particular, multicenter clinical trials have shown that the laparoscopic approach to colorectal cancer had a comparable or even better outcomes in terms of perioperative complications and functional recovery of patients than traditional surgery. Complete Mesocolic Excision (CME) in right colonic resections is a surgical approach, of greater technical complexity, that appears to improve the oncological outcomes of these patients at the cost of an increased rate of complications. The highest rate of complications reported in the literature in patients undergoing CME was related to intraoperative bleeding due to the central vascular dissection that is performed. CT technological advances have made possible to perform CT angiography with multiplanar and three-dimensional reconstructions with the possibility of obtaining a detailed preoperative map of the vascular anatomy of these patients. CT scan was acquired immediately before contrast material injection and during arterial and venous phase. Arterial phase was obtained using the bolus tracking technique with an automated scan-triggering software. Image analysis was performed using multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D volume rendering (VR) technique. The purpose of the CT was to identify three different parameters necessary for proper performance of CME and CVL and to compare preoperative observations with intraoperative evidence. All surgeries were performed by teams experienced in laparoscopic colorectal surgery. The investigators evaluated:- Fascia of Fredet; vascular structures; lymph nodes.

Detailed Description
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x

Official Title
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Complete Mesocolic Excision (CME) and Central Vascular Ligation (CVL) in Right-sided Colon Cancer: Surgical and Radiological Assessment. A Prospective Observational Study (RACOMERC)

Conditions
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Right-sided Colon Cancer

Intervention / Treatment
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* Procedure: Laparoscopic right colonic resection with Complete Mesocolic Excision (CME)
* Radiation: 3D CT angiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with diagnosis of right-sided colon cancer patients underwent to CT angiography laparoscopic right hemicolectomy with CME and CVL. Exclusion Criteria: metastatic disease palliative treatment impossibility to perform CT angiography patients underwent to a traditional colonic resection with D2 lymphadenectomy.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Laparoscopic right colonic resection with Complete Mesocolic Excision (CME)|nan|
|Radiation: 3D CT angiography|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preoperative radiologic assessment of patients with diagnosis of right-sided colon cancer. The investigators evaluated: fascia of Fredet; vascular structures (ileocolic vessels; right colic artery, middle colic artery, trunk of Henle); lymph nodes. | Evaluation of preoperative CT scan features during enrollment of patients. | Evaluation of preoperative CT scan features during enrollment of patients. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perioperative outcomes: intraoperative complications | complication occurred during surgery | intraoperative time | 
| Perioperative outcomes: postoperative complications | complication occurred in postoperative period | up to 30 days postoperative | 
| Perioperative outcomes: mean operative time | operative time | intraoperative time | 
| perioperative outcomes: rate of conversion | rate of conversion from laparoscopy to open surgery | intraoperative time | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Right colon cancer, complete mesocolic excision, CT abdominal scan