Complete Mesocolic Excision in Comparison With Conventional Surgery for the Right Colon Cancer
Complete Mesocolic Excision With Central Vascular Ligation in Comparison With Conventional Surgery for the Right Colon Cancer: An Italian Randomized Trial
University of Turin, Italy
416 participants
Jul 13, 2020
INTERVENTIONAL
Conditions
Summary
An Italian randomized controlled trial parallel-group in patients with a malignant tumor of the right or proximal transverse colon requiring right hemicolectomy.
Eligibility
Inclusion Criteria3
- American Society of Anesthesiologists(ASA) grade I-III.
- Right colon cancer (\*The right-sided location of the cancer is defined as the location from the caecum up to the proximal third of the transverse colon), preoperative assessment of tumor stage T2-T4a, any N or T any N+ according to the National Comprehensive Cancer Network(NCCN) clinical practice guidelines in oncology: colon cancer version 2.2015); no distant metastasis.
- Informed consent
Exclusion Criteria12
- Age \> 85 years old.
- T1, N0
- T4b, any N
- BMI \> 30.
- Metastatic disease (Abdominal and chest CT scan will be mandatory to exclude distant metastasis.)
- American Society of Anesthesiologists(ASA) grade IV.
- History of cancer in recent 5 years.
- Need for Emergency surgery.
- Infectious disease requiring treatment.
- Pregnancy.
- Use of systemic steroids.
- No history of familial adenomatous polyposis, ulcerative colitis or Crohn's disease.
Interventions
Transecting the Ileocolic Vein and Artery close to the Superior Mesenteric Vessels without clearing the superior mesenteric vein (SMV) from the adipose tissue. Transecting the Right Colic Vein and Artery and superior right colic vein (when present) peripherally. Transecting the Right branches of the Middle Colic Vein (MCV) and the Middle Colic Artery (MCA) peripherally, without clearing the main trunk of the MCV and the MCA. The Right Gastroepiploic Vein and artery are never transacted.
Separation of the visceral fascia from the parietal fascia by sharp dissection leaving intact mesocolon coverage. Transecting the supplying vessels at their origin from the main vessels, particularly: * The Ileocolic Vessels, The Right Colic Vessels,The superior right colic vein (when present), The Right branches of the Middle Colic Vein and of the Middle Colic Artery * The MCV and MCA at their origin in case of cancer of the hepatic flexure or of the proximal third of the transverse colon, as well as The Right Gastroepiploic Vessels at their origin from the gastrocolic trunk of Henle (GCTH) and the gastroduodenal artery. The SMV should be cleared from all adipose tissue all along its anterior surface until its intrapancreatic entrance.
Locations(14)
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NCT04871399