Surgical Anatomy and 'Waisting' of the sIgmoid SpEcimen (WISE)

September 13, 2018 updated by: Royal Marsden NHS Foundation Trust
Treatment of rectal cancer has improved to the extent that its local recurrence rates are now much lower than other sites in the large bowel. It has been found that higher rates of recurrence in the sigmoid section of the colon, just before the rectum. This might be due to a narrowing in the bowel, and difficulties identifying whether cancers are in the sigmoid or rectum. The aim is to investigate the bowel from 20 patients undergoing surgery for left sided colorectal cancer at the Royal Marsden. These patients would have routine investigations and treatments, but once the bowel has been removed, it would undergo a MRI scan and additional slices and photography during pathological analysis.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

Following surgery for a primary cancer (ie has not spread), the patient may still die from the cancer. This may be due to local or distant recurrence. Local recurrence will be near the site of the surgery; for bowel cancer, this may be at the site of the joined bowel or nearby in the abdomen. Distant recurrence will be elsewhere in the body.

Local recurrence is much more likely when there is incomplete removal of all the cancer cells at the time of surgery This can occur if the surrounding tissue, such as the bowel mesentery, is not completely removed. The bowel mesentery is the fatty tissue in which blood vessels and lymph nodes travel up to the bowel. During research into rectal cancer, it was established that there was a rectal mesentery "waist" or narrowing that made it difficult with conventional surgery to remove all the cancer cells. A modified operation gave much better cancer clearance.

Rectal cancer outcomes are now superior to other sites of large bowel cancer. Data from the Royal Marsden and elsewhere show that local recurrence rates of the sigmoid colon are approximately double that of the rectum. This may be due to 2 potential issues: a sigmoid waist, and difficulties in differentiating rectal and sigmoid cancers.

This recurrence may be due to the presence of a waist in the sigmoid mesentery. A case series from Leeds has shown initial data suggesting there is a significantly smaller area in this area. However, this study was underpowered and not conducted prospectively in a scientifically rigorous manner. If a waist was present that could prevent cancer being successfully removed, then an extended operation could be performed or radiotherapy/chemotherapy given before the operation to shrink the cancer.

The sigmoid colon is the section of bowel before the rectum. They can be differentiated by examining the bowel during or after the operation for specific landmarks (taenia coli, appendices epiploicae) that are present on the sigmoid but not on the rectum. However, these landmarks cannot be seen on a patient's pre-operative scans, making it is very difficult to tell whether a cancer is in the sigmoid or the rectum. At our institution, we use MRI to define the end of the sigmoid at MRI as the transition point from the sigmoid mesocolon to the mesorectal apex. This can be seen on sagittal views between the fanning branches of the sigmoid artery proximally and the superior rectal vein distally. On axial views, it can be seen when the rectum fixed posteriorly by the mesorectum transitions into the sigmoid hanging freely on the sigmoid mesocolon. If the distance from the anterior peritoneal reflection to the mesorectal apex on MRI or the coalescence of the taenia coli on histology correlate, it can be predicted pre-operatively on MRI whether a patient's cancer is in the sigmoid or the rectum, and what kind of treatment they should undergo.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
20

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • London, United Kingdom, SW3 6JJ
        • Royal Marsden Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients over the age of 18 years with rectal or sigmoid cancer who will be undergoing left sided colorectal resection including the anterior peritoneal reflection.

Description

Inclusion Criteria:

  • Patients over the age of 18 years with rectal or sigmoid cancer who will be undergoing left sided colorectal resection including the anterior peritoneal reflection.
  • Patients must be able to undergo colonoscopy, adequate bowel preparation, MRI and surgery.

Exclusion Criteria:

  • Patients who are unable to consent, withhold consent or withdraw consent, including patients who require an emergency operation and will be unable to give informed consent
  • Contraindication to MRI as per MHRA recommendations [36] eg implanted medical devices, severe claustrophobia
  • Distortion of the sigmoid mesentery due to tumour perforation, invasion (stage T4), or extreme bulk

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Height from peritoneal reflection to the mesorectal apex in mm, from the pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
The area of tissue in mm2 within the mesentery, from the pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross
48 hours post-surgery

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Distance in mm from the anterior peritoneal reflection to the rectosigmoid junction on MRI (mesorectal apex, insertion of the superior rectal artery, sacral promontory, inferior border of S2) vs pathology specimen (coalescence of taenia coli).
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
Height from peritoneal reflection to the mesorectal apex in mm, on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
The area in mm2 of tissue within the mesentery, on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
Height from peritoneal reflection to the mesorectal apex in mm by location (anterior, posterior, left and right lateral), on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
The area of tissue in mm2 within the mesentery by location (anterior, posterior, left and right lateral), on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
Height from peritoneal reflection to the mesorectal apex in mm, by compass direction, on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery
The diameter in mm of tissue within the mesentery by compass direction, on MRI vs pathology specimen.
Time Frame: 48 hours post-surgery
Photographs will be captured of the macroscopic whole specimen and serial cross sectional slices using a high definition camera and will be used to perform the necessary measurements for the study.
48 hours post-surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Royal Marsden NHS Foundation Trust

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Pelican Cancer Foundation

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Gina Brown, Consultant Radiologist and Professor in Cancer Imaging

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 18, 2017

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 13, 2018

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 13, 2018

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
April 5, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 26, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 1, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 14, 2018

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 13, 2018

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2018

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • CCR4686

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Sigmoid, Sigmoid Colon, Neoplasm, Cancer

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings