Colon Cancer Clinical Trial
Official title:
Laparoscopic Versus Open Complete Mesocolic Excision With Central Vascular Ligation in Right Colon Cancer
Right sided hemicolectomy is the standard type of operation for cancers in the caecum, the ascending colon.The aim of this study was to compare between laparoscopic and open complete mesocolic excision with central vascular ligation in right colon cancer.
Colorectal cancer incidence and mortality rates vary markedly around the world. Globally,
colorectal cancer is the third most commonly diagnosed cancer in males and the second in
females, with 1.65 million new cases and almost 835,000 deaths in 2015. Rates are
substantially higher in males than in females.
The right colon has a large caliber, a thin wall, and its contents are liquid; thus,
obstruction is a late event. Bleeding is usually occult. Fatigue and weakness caused by
severe anemia may be the only complaints. Tumors sometimes grow large enough to be palpable
through the abdominal wall before other symptoms appear.
Curative treatment for right colon cancer includes resection of the tumor-bearing bowel
segment. There are standard types of operations, depending on the location of the tumor. The
types of standard resections are based on the knowledge of lymphatic drainage and lymph node
anatomy.
Right sided hemicolectomy is the standard type of operation for cancers in the caecum, the
ascending colon. In 2009, Hohenberger, a German scholar, proposed the term of complete
mesocolic excision (CME), whose basic theory is mainly composed of two concepts in fetal
anatomy and surgical oncology: sharp dissection of the mesocolic plane and the parietal
plane. CME helps to keep the colonic mesentery intact, clarify the dissected area from
central lymph nodes, emphasize the importance of transecting colon-feeding blood at the root,
and increase the range of longitudinal enterotomy. Thus, CME provides a standardization of
surgeries for colon cancer.
Traditionally, approach to right colon cancer is through open exploration but this approach
has more blood loss, prolonged postoperative hospital stay, sever postoperative pain and
delayed recovery..
Laparoscopic right colectomy (LRC) for colon cancer became a well-established technique in
the surgical armamentarium of colorectal operations. It has well proved advantages: reduction
in postoperative pain, time to return of bowel function, and length of hospital stay.
The purpose of the present study was to compare between laparoscopic and open complete
mesocolic excision with central vascular ligation in right colon cancer as regards technical
feasibility, advantages and disadvantages of both procedures.
This was prospective randomized study and was carried out on 60 patients diagnosed as
operable right sided colon cancer and the patients will be divided into two groups:
Group I: Open right hemicolectomy with complete mesocolic excision with central vascular
ligation.
Group II: Laparoscopic right hemicolectomy with complete mesocolic excision with central
vascular ligation.
All patients were subjected to preoperative assessment in the form of:
- Full history.
- Clinical evaluation and body weight.
- Laboratory investigation (Complete blood picture, liver function tests, blood sugar,
blood urea, serum creatinine, prothrombin time, serum albumin and tumour markers(.
- Imaging (chest X-ray, US abdomen, CT abdomen and pelvis).
- Histopathology diagnosis (endoscopic biopsy, tissue diagnosis).
Operative technique
In patients of group I:
- A standard mechanical bowel preparation will be performed 24 hours before operation.
- The patient will be placed in the supine position and the operation will be carried out
in a standard manner.
- A midline incision of about 15 to 20 cm will be made.
- The right-sided colon will be mobilized before mesenteric division and the same vessels
will be dissected frequently.
- Ileotransverse end-to-end hand anastomosis is operated and the mesenteric defect will be
closed.
In patients of group II:
- A standard mechanical bowel preparation will be performed 24 hours before the operation.
- A high-definition laparoscope will be used.
- Under general anaesthesia the operation is carried out in standard manner, with the
patient in a modified lithotomy position.
- After achieving pneumoperitoneum (12 mm Hg), a 12-mm trocar will be placed through an
incision just above the umbilicus, and a 30-degree laparoscope will be inserted through
the 12-mm trocar. The second 10-mm trocar will be inserted at the upper left quadrant of
the abdomen for the major acting port. The third 5-mm trocar will be inserted at the
lower left quadrant for the second major active port. The fourth and fifth 5-mm trocars
will be inserted at the upper right and lower right quadrants.
- According to laparoscopic procedure, the position, composition, and spatial
relationships of the surgery planes needed for laparoscopic complete mesocolic excision
for right sided colic cancer cases are identified.
Intraoperatively, all patients will be assessed for:
- Time of the procedure.
- Amount of blood loss.
Postoperative follow up:
Patients will be followed up by the standardized follow up protocol. They will be examined by
the outpatient setting after:
- 2 weeks (post-operative) for: wound infection, leakage, pathological outcome (The tumor
node metastasis (TNM) stage, histologic grade of differentiation, number of harvested
lymph nodes, lymphovascular invasion, estimation of resection margins).
- Every 3 months for 1-2 years by: history taking, physical examination, carcinoembryonic
antigen measurement,
- Every 6 months for 1-2 years by: chest, abdomen-pelvic computed tomography for detection
of local or systemic recurrence.
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