National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study)

Abstract

Purpose Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. Methods The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien–Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. Discussion The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. Trial registration ClinicalTrials.gov: NCT04889456, May 2021.

Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation

“…In particular, the introduction of various innovative approaches within the right hemicolectomy procedure, such as intracorporeal anastomosis, extraction via the Pfannenstiel incision, and the application of CME with CVL and D2 lymphadenectomy, represent significant strides in improving clinical outcomes for patients with right-sided colon cancer [ [7] , [8] , [9] ]. In the Netherlands, a large-scale national study, called the Right study, is currently being conducted to implement the most optimal minimally invasive right hemicolectomy [ 13 ]. This technique incorporates all the aforementioned aspects, along with maintaining a low intra-abdominal pressure (IAP), which has been shown to contribute to improved short-term outcomes as well [ 14 ].…”

Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)

“…In response to these challenges, a national large-scale quality improvement program for MIRH was recently launched in the Netherlands (the Right study) 15 . As part of this project, the objectives of the current study are to standardize and optimize MIRH by reaching consensus regarding all the surgical key elements using the Delphi method, and to develop and validate a video-based CAT to quantify surgical performance and facilitate implementation of the standardized MIRH.…”