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Colon CancerNCT03045107

Intracorporeal or Extracorporeal Anastomosis After Laparoscopic Right Colectomy.

A study testing Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA) and Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA) in people with Colon Cancer and Anastomosis, run by University of Turin, Italy at 1 site in Italy.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

During the last few years, the laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA) has been proposed as an alternative to laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA) for the treatment of right colon tumors. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Colon Cancer, Anastomosis
What is being tested?
Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA) and Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA)
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
140 participants
Where
1 siteItaly
Study dates
1 Feb 2017to 30 Jul 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient diagnosed with a solitary benign or malignant neoplasm localized in the right colon
  • Patients aged 18 years or older
  • Patients who give written informed consent

Who cannot join

  • acute intestinal obstruction
  • colon perforation;
  • liver and/or lung metastases;
  • multiple primary colonic tumors;
  • scheduled need for synchronous intra-abdominal surgery;
  • preoperative evidence of invasion of adjacent structures, as assessed by CT or ultrasonography;
  • previous ipsilateral colon surgery.

Trial locations and contacts

1 site in 1 country.

Marco E Allaix, MD, PhD contact

+390116335670

mallaix@unito.it

Italy1 site, 1 recruiting
  • Department of Surgical Sciences, University of Torino, AOU Città della Salute e della Scienza

    Torino, 10126

    Marco E Allaix, MD, PhD, +390116335670, mallaix@unito.it

    Mario Morino, MD

    Recruiting

Other trials in Italy

About this study

Official title: Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy.

During the last few years, the laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA) has been proposed as an alternative to laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA) for the treatment of right colon tumors. However, the level of evidence coming from the currently available literature is low, based on the results of a few small and heterogeneous retrospective non-randomized studies. A randomised controlled trial is warranted to challenge these two procedures. The aim of this randomized controlled trial is to assess the outcomes after IIA or EIA after laparoscopic right colectomy for right colon tumors.

Read the detailed description

While there are no differences in oncologic principles (no touch technique, proximal vessel ligation, lymphadenectomy) between laparoscopic right colectomy with IIA and EIA, potential advantages of IIA are: (1) no need for extensive mobilization of the transverse colon to reach the abdominal wall; (2) performing the anastomosis away from the abdominal wall may lead to reduced rates of superficial site infection; (3) a shorter incision for the specimen extraction may be associated with clinical benefits such as less pain and lower rates of superficial site infections; (4) laparoscopic visualization during the creation of the IIA may reduce unrecognized twisting of the terminal ileum mesentery, and (5) the ability to remove the specimen through any type of incision, with subsequent reduced risks of incisional hernias in case of Pfannenstiel incision when compared to midline or off-midline incisions.

Some retrospective and heterogeneous studies comparing perioperative outcomes after laparoscopic right colectomy with EIA and IIA have been published in the last decade, reporting controversial results. Furthermore, the results of recent metanalyses are challenged by the heterogeneity and the poor quality of the published studies. Lastly, no comprehensive economic evaluation of the two procedures have been performed yet.

Consecutive patients with right colon tumors are included in a randomized controlled trial. This is a single Institution prospective randomized controlled trial comparing the outcomes in patients undergoing laparoscopic right colectomy with IIA or EIA for right colon neoplasm. Eligible patients will be randomly assigned in a 1:1 ratio to undergo either laparoscopic IA or EA according to a list of randomization numbers with treatment assignments. This list will be computer generated. An Internet application will allow central randomization.

Cost analysis will be based on the following costs: surgical instruments (including re-usable trocars and disposable tools), operative room, routine postoperative surgical care, diagnosis and treatment of postoperative complications. Operative room costs include healthcare personnel, medications, and structure costs. To calculate the cost of each postoperative complication, the following items will be assessed: laboratory and microbiology analysis; medical, technical, and diagnostic services; surgical and therapeutic interventions; medications; prolonged hospital stay, and outpatient clinic follow-up. The mean length of hospital stay of uncomplicated patients will be the basis to calculate the prolonged hospital stay in each patient with complication. In patients who will develop multiple complications, resources used to treat each complication will be recorded separately.

Being tested
Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA), Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA)
Keywords
right colon, laparoscopic right colectomy, intracorporeal anastomosis, extracorporeal anastomosis, hospital stay, quality of life, costs
Medical subject headings
Colonic Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA)Procedure or surgery

    After complete right colon mobilization and ileocolic and right colic vessels ligation, the proximal transverse colon and the terminal ileum are transected with a laparoscopic EndoGIA TM stapler (Covidien Medtronic). The antimesenteric side of the stapled ends of the transverse colon and terminal ileum are approximated by a stay suture tied intracorporeally and then held by the assistant. An antimesenteric enterotomy and an antimesenteric colotomy are made about 10 cm distal to the stapled ends of the transverse colon and terminal ileum, respectively. A side-to-side anastomosis is fashioned with a laparoscopic EndoGIA TM stapler (Covidien Medtronic). The enterotomies are then closed by two layers of reabsorbable sutures tied intracorporeally. The specimen is delivered through a small Pfannenstiel or a median incision. A big dressing covering all incisions will be applied, similar to that used for the EIA group.

  • Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA)Procedure or surgery

    After complete right colon mobilization and ileocolic and right colic vessels ligation, the terminal ileum, right colon, and proximal transverse colon are exteriorized for bowel division through a small midline skin incision in the upper abdomen. A primary ileocolic side-to-side handsewn or mechanical (with GIA stapler - Covidien Medtronic) anastomosis is fashioned and the bowel returned to the abdominal cavity. After reinduction of pneumoperitoneum, the lack of twists of the ileocolic anastomosis is checked. A big dressing covering all incisions will be applied.

Study groups in NCT03045107
Study groupRoleWhat they receive
Intracorporeal ileocolic anastomosis (IIA)ExperimentalAfter complete right colon mobilization and ileocolic and right colic vessels ligation, the proximal transverse colon and the terminal ileum are transected and a side-to-side anastomosis is fashioned with a laparoscopic stapler.
Receives: Procedure: Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA)
Extracorporeal ileocolic anastomosisActive comparatorAfter complete right colon mobilization and ileocolic and right colic vessels ligation, the terminal ileum, right colon, and proximal transverse colon are exteriorized for bowel division through a small midline skin incision in the upper abdomen. Then, a primary ileocolic side-to-side handsewn or mechanical anastomosis is fashioned extracorporeally.
Receives: Procedure: Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Length of hospital stay

    Measured: 1 month

Secondary outcomes (13)
  1. Length of incisions

    Measured: At the end of the operation

  2. Intraoperative complications

    Measured: intraoperatively

  3. Number of lymph nodes harvested

    evaluation of the number of lymph nodes in the specimen on pathology report

    Measured: 3 weeks

  4. 30-day postoperative morbidity according to the Clavien-Dindo classification

    Measured: 1 month

  5. First gas and stool passage

    Measured: 1 week

  6. Evaluation of postoperative pain (VAS)

    measurement of VAS scores

    Measured: 1 week

  7. Duration of intravenous analgesic therapy

    Measured: 1 week

  8. Narcotics use rate

    percentage of patients requiring narcotics after surgery

    Measured: from day 1 to day 5 after surgery

  9. Reoperation rate

    Measured: 1 week

  10. Hospital readmission

    rate and causes of hospital readmission

    Measured: 90 days

  11. In-hospital costs

    Cost analysis will be based on the following costs: surgical instruments (including re-usable trocars and disposable tools), operative room, routine postoperative surgical care, diagnosis and treatment of postoperative complications. Operative room costs included healthcare personnel, medications, and structure costs. To calculate the cost of each postoperative complication, the following items will be assessed: laboratory and microbiology analysis; medical, technical, and diagnostic services; surgical and therapeutic interventions; medications; prolonged hospital stay, and outpatient clinic follow-up. The mean length of hospital stay of uncomplicated patients will be the basis to calculate the prolonged hospital stay in each patient with complication. In patients who will develop multiple complications, resources used to treat each complication will be recorded separately.

    Measured: 60 days

  12. Rate of incisional hernias

    Measured: postoperatively at 3 and 6 months

  13. Quality of life

    the SF-12 questionnaire will assess quality of life

    Measured: preoperatively, at 3 and 6 months after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Feb 2017 (estimated)
  2. Study start1 Feb 2017
  3. Primary completion31 Jan 2020 (estimated)
  4. Study completion30 Jul 2020 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
140 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03045107
Sponsor's protocol ID
CS 863
Status last verified
May 2017
First submitted
3 Feb 2017
Last updated
4 May 2017
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hellan M, Anderson C, Pigazzi A. Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS. 2009 Jul-Sep;13(3):312-7.

    PubMed 19793468
  • Fabozzi M, Allieta R, Brachet Contul R, Grivon M, Millo P, Lale-Murix E, Nardi M Jr. Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study. Surg Endosc. 2010 Sep;24(9):2085-91. doi: 10.1007/s00464-010-0902-8. Epub 2010 Feb 21.

    PubMed 20174945
  • Grams J, Tong W, Greenstein AJ, Salky B. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc. 2010 Aug;24(8):1886-91. doi: 10.1007/s00464-009-0865-9. Epub 2010 Jan 29.

    PubMed 20112118
  • Chaves JA, Idoate CP, Fons JB, Oliver MB, Rodriguez NP, Delgado AB, Lizoain JL. [A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy]. Cir Esp. 2011 Jan;89(1):24-30. doi: 10.1016/j.ciresp.2010.10.003. Epub 2010 Dec 19. Spanish.

    PubMed 21176829
  • Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I. Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg. 2012;10(6):290-5. doi: 10.1016/j.ijsu.2012.04.020. Epub 2012 May 4.

    PubMed 22564829
  • Scatizzi M, Kroning KC, Borrelli A, Andan G, Lenzi E, Feroci F. Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case-control study. World J Surg. 2010 Dec;34(12):2902-8. doi: 10.1007/s00268-010-0743-6.

    PubMed 20703468
  • Milone M, Elmore U, Di Salvo E, Delrio P, Bucci L, Ferulano GP, Napolitano C, Angiolini MR, Bracale U, Clemente M, D'ambra M, Luglio G, Musella M, Pace U, Rosati R, Milone F. Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc. 2015 Aug;29(8):2314-20. doi: 10.1007/s00464-014-3950-7. Epub 2014 Nov 21.

    PubMed 25414066
  • Hanna MH, Hwang GS, Phelan MJ, Bui TL, Carmichael JC, Mills SD, Stamos MJ, Pigazzi A. Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc. 2016 Sep;30(9):3933-42. doi: 10.1007/s00464-015-4704-x. Epub 2015 Dec 29.

    PubMed 26715015
  • van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, Tuynman J. Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc. 2017 Jan;31(1):64-77. doi: 10.1007/s00464-016-4982-y. Epub 2016 Jun 10.

    PubMed 27287905
  • Seno E, Allaix ME, Ammirati CA, Bonino MA, Arezzo A, Mistrangelo M, Morino M. Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: cost analysis of the Torino trial. Surg Endosc. 2023 Jan;37(1):479-485. doi: 10.1007/s00464-022-09546-7. Epub 2022 Aug 23.

    PubMed 35999317
  • Allaix ME, Degiuli M, Bonino MA, Arezzo A, Mistrangelo M, Passera R, Morino M. Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy: A Double-blinded Randomized Controlled Trial. Ann Surg. 2019 Nov;270(5):762-767. doi: 10.1097/SLA.0000000000003519.

    PubMed 31592811

Questions about this trial

What is this clinical trial studying?

A study testing Laparoscopic right colectomy with intracorporeal ileocolic anastomosis (IIA) and Laparoscopic right colectomy with extracorporeal ileocolic anastomosis (EIA) in people with Colon Cancer and Anastomosis, run by University of Turin, Italy at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 4 May 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Marco E Allaix, MD, PhD (+390116335670, mallaix@unito.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Length of hospital stay (time frame: 1 month). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03045107, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 May 2017.

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