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Surgical procedures for gastrointestinal oncology intervention are inevitably highly variable amongst surgeons and centers. Although acceptable to a degree, a substantial proportion of this variability has a potential relevance for both short term clinical outcomes and long term survival. For patients with right-sided colon cancer, a laparoscopic right hemicolectomy (LRHC) is the surgical procedure to remove the cancer and locoregional lymph nodes. This surgical technique has evolved during the last decade with the introduction of the intracorporeal anastomosis, the Pfannenstiel extraction and the complete mesocolic excision (CME). The latter is a dissection technique in embryological planes with a central vascular ligation of the segmental branches at its origin, resulting in an optimal lymphadenectomy. Given the insights from recent studies showing a positive association between the quality of surgery and relevant clinical outcomes, there is a great need to reduce the interinstitutional and intersurgeon variability and to implement an optimized and standardized surgical technique for right-sided colon cancer in the Netherlands to improve short- and long-term clinical and oncological outcomes. This kind of implementation needs a consensus of the key elements of the procedure and a formative quality assessment of LRHC. Detailed objective assessment of the LRHC is currently not performed in clinical practice nor in surgical training. Quality assessment of LRHC has great potential to improve surgical training and furthermore, implementation of a standardized technique will ultimately lead to better quality of care for patients suffering from right-sided colon cancer. 

The main objective of this study is to improve surgical outcomes for patients with right-sided colon cancer by a prospective sequential interventional cohort study that aims to standardize the surgical technique with subsequent controlled implementation after standardized review of the current practice in a nationwide multicenter setting.  

Prospective interventional sequential cohort study with 5 phases.

• Planned laparoscopic or robot-assisted (extended) right hemicolectomy for colon cancer (adenocarcinoma) of the caecum, ascending colon, hepatic flexure or proximal transverse colon;
• Age above 18 years;                    
• Signed informed consent.

• cT4b/multivisceral resection;
• cTNM stage 4 (M1);
• ASA 4; 
• Immune modulating medication;
• Prior midline or transverse laparotomy larger than 10 cm (not including Pfannenstiel and McBurney’s incision);
• Perforated disease/peritumoral abscess/fistula;
• Acute obstruction;
• Emergency surgery;
• Neuroendocrine neoplasm (NEN);
• Other primary malignancy treated within 5 years from diagnosis of colon cancer, except for curatively treated prostate, breast, skin and cervical cancer.

Algemeen

Nieuwsbrieven

Ziekenhuizen

Admiraal De Ruyter Ziekenhuis

Albert Schweitzer Ziekenhuis

Amstelland Ziekenhuis

Amsterdam UMC, locatie VUmc

Amsterdam UMC, locatie AMC

Antoni van Leeuwenhoek

Beatrixziekenhuis Rivas Zorggroep

Canisius Wilhelmina Ziekenhuis

Deventer Ziekenhuis

Diakonessenhuis Utrecht

Elisabeth-TweeSteden Ziekenhuis

Flevoziekenhuis

Franciscus Gasthuis Vlietland

Gelre Ziekenhuizen

Groene Hart Ziekenhuis

Haaglanden Medisch Centrum

IJsselland Ziekenhuis

Ikazia Ziekenhuis

Isala Ziekenhuis

LangeLand Ziekenhuis

Laurentius Ziekenhuis

Leids Universitair Medisch Centrum

Maastricht Universitair Medisch Centrum

Maasziekenhuis Pantein

Meander Medisch Centrum

Medisch Centrum Leeuwarden

Medisch Spectrum Twente

Nij Smellinghe

Onze Lieve Vrouwe Gasthuis

Rode Kruis Ziekenhuis

Rijnstate Ziekenhuis

Sint Jansgasthuis

Spaarne Gasthuis

Stichting ZorgSaam Zeeuws Vlaanderen

Treant Zorggroep

Van Weel-Bethesda Ziekenhuis

VieCuri Medisch Centrum

Zaans Medisch Centrum

Ziekenhuis Gelderse Vallei

Ziekenhuisgroep Twente

Ziekenhuis St Jansdal

Zuyderland Medisch Centrum