Standardizing Right Hemicolectomy for Colon Cancer

• Prospective mapping of current practice with surgical variations in laparoscopic right hemicolectomy (total duration of inclusion 3 months) N= 40 centers N = 310 videos

• METC approval for the use of anonymized videos of a laparoscopic procedure and collection of corresponding clinical outcomes.
• Approaching hospitals for participation (high volume centers (50+ colon cancers).
• Prospective inclusion of consecutive patients undergoing laparoscopic right hemicolectomy in the participating hospitals in three months.
• Development of Standard Laparoscopic Right Hemicolectomy: an (inter)national Delphi study

• Approaching specialists to participate in the Delphi method (from participating hospitals in step 1).
• Identification of crucial steps and measures according to literature and expert's opinion (Delphi method).
• Documentation of steps and the order in which they need to be performed, development of a competency assessment tool (CAT).
• Skills center training facility

a. Training the participating surgeons in the method of the standardized laparoscopic right hemicolectomy, as consented in the Delphi method.

• Implementation of the standardized laparoscopic right hemicolectomy with proctoring during another period with prospective inclusion of consecutive patients with collection of surgical videos in all participating hospitals (N=40 centers, total 310 videos)

• Rating videos.
• Comparing with pre-implementation performance based on outcome measures reflecting oncological quality of surgery, and 30-day clinical outcomes.
• Comparing with pre-implementation performance based on the long-term outcomes. (3-year DFS and 5-year OS).
• Implementing standardised lap right hemicolectomy (after learning curve without proctoring)

• Consecutive inclusion of patients (n=310)
• CT imaging
• Video analysis
• Competency analysis
• Variation analysis
• Clinico pathological data

Inclusion criteria

• Planned laparoscopic (extended) right hemicolectomy for colon cancer of the caecum, ascending colon or hepatic flexure;
• Age above 18 years;
• cTNM stage 1-3 (CT-staged);
• No prior midline or transverse laparotomy;
• ASA1-3;
• No immune modulating medication.

Exclusion criteria

• cT4b;
• Perforated disease;
• Acute obstruction;
• Emergency operation;
• Appendiceal cancer;
• Other primary malignancy treated within 5 years from diagnosis of colon cancer, except for curatively treated prostate, breast, skin and cervical cancer.