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Oxygen reserve index and partial oxygen pressure will be noted for patients undergoing hemicolectomy

Hemicolectomy

cigdem akyol beyoglu

Oxygen reserve index (ORI) measured by multiple wave pulse co-oximeter is a new technological development in medical science. Our aim in this study is to identify the correlation between arterial oxygen pressure (PaO2) and ORI, and to identify the specificity and sensitivity of ORI as a tool to prevent hypoxia and hyperoxia in abdominal surgery patients.

Patients aged between 20-55 years old,American Society of Anesthesiologists physical status 1-2 who will have hemicolectomy will be included to the study. If hemodynamic instability or a sudden decrease in oxygen saturation by pulse oximetry (SpO2) occurs, arterial blood gas analysis will be taken from the patient and ORI, SpO2, PaO2, and arterial oxygen saturation (SaO2) will be recorded. The primer endpoint of the study is to identify the correlation between PaO2 and ORI, seconder end-point is to identify the specificity and sensitivity of ORI as a detector of PaO2. Pearson test for correlation, regression analysis for sensitivity and specificity will be performed. The study will include 240 patients according to power analysis

Correlation Between Partial Oxygen Pressure and Oxygen Reserve Index

Evaluation of the Correlation Between Partial Oxygen Pressure and Oxygen Reserve Index, and Sensitivity and Specificity of Oxygen Reserve Index in Patients Undergoing Hemicolectomy

Istanbul University

Herbal and Botanical

All Drugs and Chemicals

Cola

participants diagnosed as operable right sided colon cancer were enrolled in this study and did open combined medial and caudal resection procedure

participants diagnosed as operable right sided colon cancer were enrolled in this study and did laparoscopic combined medial and caudal resection procedure

resection of right colon cancer by this radical approach

combined medial and caudal approach right hemicolectomy open and laparoscopic

Reham Z Mohamed, master

Ali H Elshewy, PhD

Abdelrahman A Sarhan, PhD

Gamal M Osman, PhD

Right sided hemicolectomy is the standard type of operation for cancers in the caecum, the ascending colon, proximal transverse colon.The aim of this study was to assess the safety and feasibility of combined medial and caudal approach in performing right hemicolectomy and to compare outcome between laparoscopic and open surgery in right colon cancer.

The incidence of colorectal cancer is increasing. Slight shift towards right colon cancer is noticed in the last 2 decades in Egypt. This can be attributed to advances in diagnostic tools and increased public health awareness as right sided colon cancer was almost presented late as most of tumors located in the capacious cecum. Hence, early diagnosis with good radical procedure offers better outcome, quality of life and survival. Many approaches for right colon resection were described. In this study we adopted the combined medial and caudal approach for right colon resection in cases of right colon cancer in both open and laparoscopic techniques.

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.

As combined medial and caudal approach is a radical procedure,the purpose of the present study was to compare between laparoscopic and open right hemicolectomy both done with combined medial and caudal approach in right colon cancer as regards technical feasibility, advantages and disadvantages of both procedures.

This was prospective randomized study and was carried out on 26 participants as number of cases with right hemicolon cancer is about 2 per month in our center. Those participants diagnosed as operable right sided colon cancer and the participants were divided into two groups:

Group I: Open combined medial and caudal right hemicolectomy included 13 participants Group II: Laparoscopic combined medial and caudal right hemicolectomy included 13 participants

All patients with inclusion criteria were subjected to preoperative assessment in the form of:

* Full history.
* Clinical evaluation.
* Laboratory investigation (Complete blood picture, liver function tests, blood sugar, blood urea, serum creatinine, prothrombin time, serum albumin and tumour marker CEA).
* Imaging (chest X-ray, US abdomen, CT abdomen and pelvis).
* Histopathology diagnosis (endoscopic biopsy, tissue diagnosis).
* Determined whether participants underwent open or laparoscopic operation is multifactorial e.g., patients desire, contraindications for laparoscopy and mass size if more than 5 cm preferred to have open surgery.
* Informed written consent taken from the patients or the legal guardian.

operative technique: both groups offered combined medial and caudal approach

* Fasting for 6 hours with no oral intake or only clear fluids intake the day before or better bowel preparation.
* After confirming the availability of blood of matching blood group, general anesthesia is inducted and prophylactic antibiotics are given.
* Patient positioning:

  1. group I: (Open cases) The standard position for an open right hemicolectomy is supine with strapping of the ankle and wrists, such as the Trendelenburg position. The surgeon stands on the patient's left, and the first assistant stands across from the surgeon on the patient's right. The scrub nurse stands beside the surgeon. If a second assistant is needed, he or she usually stands across from the surgeon to the left of the first assistant.
  2. group II: laparoscopic cases: The patient should be placed in the supine position with his two legs apart and arms tucked beside the body.

The surgeon should stand between the patient's legs with the assistant standing on the patient's left and the camera operator standing on the assistant's left side, and the scrub nurse on the patient's right side.

The video monitor is placed on the patient's upper right.

* Abdominal access and trocar placement by open or closed technique using veress needle for pneumoperitoneum with an intraperitoneal pressure of 14 mmHg.
* The procedure requires 5 trocars.
* A 10 mm trocar is placed 3 cm below umbilicus for the 30° angled telescope to get an adequate view. The incision would be enlarged to extract the specimen and performing anastomosis.
* A12 mm trocar is introduced 5 cm below the telescope port for the surgeon right hand instrument.
* A 5 mm port is inserted at the McBurney's point for the surgeon's left hand instrument.
* Additional two 5 mm trocars are placed at the opposite of McBurney's point and the right subcostal position respectively for the assistant to retract and display the colon and mesocolon.

Intraoperatively, all patients will be assessed for:

* Time of the procedure.
* Amount of blood loss.

post operatively: Postoperative medications given. Monitoring of vital signs and drains. post operative assesment of pain is subjective to the participant as he gave it a score from 1 to 10. minimal pain score(1 to 3), mild (4 to 6) and sever (7 to 10). Ambulation and clear oral fluids started when intestinal sounds are audible followed by soft diet. The intraperitoneal tube drain removed when there is less than 50cc of fluid per 24h or after performing ultrasonography.

Follow up:

Participants are reviewed as outpatients weekly for 1 month or more frequent if they develop any complications between their visits.

The postoperative pathological results, number of lymph node dissection, postoperative exhaust time, postoperative abdominal drain volume and duration, postoperative short term complications, hospital stay and postoperative pathological staging will be recorded.

all participants underwent right hemicolectomy using combined medial and caudal approach and divided into 2 groups group I had open surgery and group II had laparoscopic surgery

Combined Medial and Caudal Approach for Right Hemicolectomy

Safety and Feasibility of the Combined Medial and Caudal Approach in Open and Laparoscopic Radical Right Hemicolectomy for Right Colon Cancer

researchers should contact the principle investigator for individual participant data

The duration of operation was calculated in minutes in both groups. group I: open combined medial and caudal right hemicolectomy and group II: laparoscopic combined medial and caudal right hemicolectomy from skin incision till skin closure intraoperatively.

the amount of blood loss during operation is calculated in cubic centimetres using scaled container connected to suction device in both groups.

detection of organ or visceral injury was done intra operatively by naked eye in both groups.

the duration of hospital stay was detected in days in both groups

the number of resected lymph nodes was detected in post operative histopathological reports in both groups.

detection of post operative pain was detected in both groups using a written scale fulfilled by the participant giving a score from 1 out of 10 points (1 to 3 points referred as minimal) (4 to 6 points referred as mild) (7 to 10 points referred as sever).

occurrence of fecal fistula in both groups was detected by vision of fecal discharge in drains from 48 hours post operatively till discharge day.

post operative wound infection in both groups was detected by vision of wound discharge or pus.

Zagazig University

assistant lecturer of general surgery

Rectal Diseases

An extended right hemicolectomy with total mesocolic excision and meticulous central dissection as described by Hohenberger will be performed with the DaVinci Xi robot by one of two dedicated surgeons

Robot-assisted laparoscopic extended right colectomy

Hans B Rahr, MD DMSc

Lars Bundgaard, MD

Helle Gangelhof, RN

A single-center prospective study to elucidate whether extended robot-assisted right colectomy (e-RARC) performs as well as extended open right colectomy (e-ORC) in terms of specimen quality, and in addition, whether less postoperative morbidity and shorter length of stay (LOS) can be attained. Patients with colonic cancer near the right flexure or the oral part of the transverse colon will be compared excluding the most technically demanding and frail patients in both groups. A total of 40 patients undergoing e-RARC in a prospective series will be included and compared with 44 consecutive patients previously treated with e-ORC.

Complete mesocolic excision with central vascular ligation (CME) is an improvement of surgical technique in the operation for colonic cancer suggested to increase long-term survival. The concept was originally developed for open surgery by W. Hohenberger in Erlangen with excellent survival rates. However, if the tumor is located in the transverse colon or near the right colonic flexure, the procedure is particularly technically demanding, and for that reason most surgeons still prefer to do it by open operation (laparotomy) instead of the minimally invasive approach (laparoscopy) presently recommended for colonic cancer surgery. The advent of robotic surgery has improved the dexterity of instruments used in laparoscopic surgery and pushed the limits of what is possible with a minimally invasive approach. Since minimally invasive surgery is associated with better outcomes in terms of postoperative morbidity, pain, length of stay etc., it would be highly desirable if CME surgery could be done by robot-assisted laparoscopic operation instead of the current open approach. The current single-center study is proposed to elucidate whether extended robot-assisted right colectomy (e-RARC) performs as well as extended open right colectomy (e-ORC) in terms of specimen quality, and in addition, whether less postoperative morbidity and shorter length of stay (LOS) can be attained. Patients with colonic cancer near the right flexure or the oral part of the transverse colon will be compared excluding the most technically demanding and frail patients in both groups. A total of 40 patients undergoing e-RARC in a prospective series will be included and compared with 44 consecutive patients previously treated with e-ORC.

Prospective single-arm study with historical controls

Prospective Study of Extended Robotic Right Hemicolectomy With Complete Mesocolic Excision for Cancer

A Single Center Prospective Study Comparing Robot-assisted and Open Operation With Complete Mesocolic Excision (CME) in Extended Right Colectomy for Colon Cancer in the Right Flexure and Transverse Colon

Minutes from first incision to final stitch

Percentage of conversions from robotic to open surgery

As judged by pathologist (mesocolic/intramesocolic/intramuscular)

Number of nodes in specimen, as determined by pathologist

Postoperative complications, graded by Clavien-Dindo

Reinterventions under anesthesia before discharge from hospital

Days from operation to discharge from hospital

Readmissions to hospital 1-30 days after initial discharge

Vejle Hospital

Rare Diseases

Adenocarcinoma

Appendiceal Neoplasms

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Cecal Neoplasms

Cecal Diseases

Adenocarcinoma of the Appendix

Patients with appendiceal cancer who underwent segmental resection of appendiceal adenocarcinoma

Patients with appendiceal cancer who underwent formal right hemicolectomy of appendiceal adenocarcinoma

Segmental resection of appendiceal adenocarcinoma including terminal ileum and cecum

Partial colecctomy

Formal right hemicolectomy including terminal ileum, cecum, and ascending colon

A few studies investigated the predictors of overall survival in appendiceal adenocarcinoma. A SEER database analysis of 1404 patients with appendiceal adenocarcinoma found that older age, T4 tumors, N1-2 stage, poorly differentiated carcinoma, and distant metastasis were significantly predictive of poorer survival. Another small single-center study including 49 appendiceal cancer patients reported female gender and low-grade adenocarcinoma to be associated with increased overall survival. However, these previous analyses did not take into account some important prognosticators of survival such as patients' comorbidities and functional status, pathologic parameters such as lymphovascular invasion, and adjuvant systemic treatment. Therefore, we used the National Cancer Database (NCDB) to conduct a comprehensive analysis of the predictors of overall survival after surgical treatment of stage I-III appendiceal adenocarcinoma.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Correlation Between Partial Oxygen Pressure and Oxygen Reserve Index	NCT02707796	COLON CANCER	Hemicolectomy	20 Years - 55 Years	Istanbul University
Combined Medial and Caudal Approach for Right Hemicolectomy	NCT05128708	Colon Cancer	combined medial...	20 Years - 80 Years	Zagazig University
Prospective Study of Extended Robotic Right Hemicolectomy With Complete Mesocolic Excision for Cancer	NCT04190589	Colorectal Canc...	Robot-assisted ...	18 Years -	Vejle Hospital
Surgical Outcome and Predictors of Overall Survival of Stage I-III Appendiceal Adenocarcinoma	NCT05452382	Appendiceal Can...	Partial colecct... Hemicolectomy	-	Mansoura University
Prospective Study of Extended Robotic Right Hemicolectomy With Complete Mesocolic Excision for Cancer	NCT04190589	Colorectal Canc...	Robot-assisted ...	18 Years -	Vejle Hospital
Correlation Between Partial Oxygen Pressure and Oxygen Reserve Index	NCT02707796	COLON CANCER	Hemicolectomy	20 Years - 55 Years	Istanbul University
Combined Medial and Caudal Approach for Right Hemicolectomy	NCT05128708	Colon Cancer	combined medial...	20 Years - 80 Years	Zagazig University
Combined Medial and Caudal Approach for Right Hemicolectomy	NCT05128708	Colon Cancer	combined medial...	20 Years - 80 Years	Zagazig University

Spots Global Cancer Trial Database for hemicolectomy