- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00726622
Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Rectal Cancer
A Phase III Prospective Randomized Trial Comparing Laparoscopic-Assisted Resection Versus Open Resection for Rectal Cancer
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a multicenter study. Patients eligible for this trial will have completed 5FU based neoadjuvant chemotherapy/radiation therapy per the institution's standard of care or IRB approved clinical trial. Patients may be registered/randomized anytime after completion of neoadjuvant therapy, but surgery must occur within 4-12 weeks (28-84 days) after completion of neoadjuvant therapy. Patients are stratified according to the site of the primary tumor (high, middle or low rectum), registering surgeon, and planned operative procedure (low anterior resection or abdominal perineal resection). Patients are randomized to 1 of 2 treatment arms. Please see the arms section for more details. The primary and secondary objectives are listed below.
Primary Objective:
To test the hypothesis that laparoscopic-assisted resection for rectal cancer is not inferior to open rectal resection, based on a composite primary endpoint of oncologic factors which are indicative of a safe and feasible operation.
Secondary Objectives:
To assess patient-related benefit of laparoscopic-assisted resection for rectal cancer vs.
open rectal resection (blood loss, length of stay, pain medicine utilization)
- To assess disease free survival and local pelvic recurrence at two years.
- To assess quality of life, sexual function, bowel and stoma function at scheduled time points throughout the trial.
Patients will be evaluated after surgery to determine the need for subsequent care based on the final pathology. Patients should not start treatment on any other investigative trial involving intervention or invasive diagnostic procedures ≤ 30 days following surgery to enable a complete evaluation of post-operative adverse events and complications occurring within 30 days of surgery. Patients are followed periodically for up to 5 years post surgery.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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British Columbia
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Vancouver, British Columbia, Canada, V6Z 1Y6
- St. Paul's Hospital at Providence Health Care - Vancouver
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Ontario
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Hamilton, Ontario, Canada, L8N 4A6
- St. Joseph's Hospital - Charlton Campus
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Arizona
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Scottsdale, Arizona, United States, 85259-5499
- Mayo Clinic Scottsdale
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California
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Concord, California, United States, 94524-4110
- Cancer Care Center at John Muir Health - Concord Campus
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Los Angeles, California, United States, 90027
- Kaiser Permanente Medical Center - Los Angeles
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San Francisco, California, United States, 94118
- California Pacific Medical Center - California Campus
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Walnut Creek, California, United States, 94598
- John Muir/Mt. Diablo Comprehensive Cancer Center
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Florida
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Weston, Florida, United States, 33331
- Cleveland Clinic Florida - Weston
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Georgia
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Columbus, Georgia, United States, 31904
- John B. Amos Cancer Center
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Illinois
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Chicago, Illinois, United States, 60611-3013
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University
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Evanston, Illinois, United States, 60201-1781
- Evanston Hospital
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Indiana
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Carmel, Indiana, United States, 46032
- Clarian North Medical Center
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Indianapolis, Indiana, United States, 46202-5289
- Indiana University Melvin and Bren Simon Cancer Center
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Indianapolis, Indiana, United States, 46202
- William N. Wishard Memorial Hospital
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Indianapolis, Indiana, United States, 46202
- Veterans Affairs Medical Center - Indianapolis
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Mooresville, Indiana, United States, 46158
- Kendrick Regional Center for Colon and Rectal Care - Mooresville
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Iowa
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Iowa City, Iowa, United States, 52242-1002
- Holden Comprehensive Cancer Center at University of Iowa
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Massachusetts
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Burlington, Massachusetts, United States, 01805
- Lahey Clinic Medical Center - Burlington
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Michigan
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Grand Rapids, Michigan, United States, 49506
- Blodgett Hospital at Spectrum Health
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Minnesota
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Rochester, Minnesota, United States, 55905
- Mayo Clinic Cancer Center
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Missouri
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Columbia, Missouri, United States, 65201
- Boone Hospital Center
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Saint Louis, Missouri, United States, 63110
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
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New Jersey
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Summit, New Jersey, United States, 07901
- Overlook Hospital
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New York
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New York, New York, United States, 10065
- Memorial Sloan-Kettering Cancer Center
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Stony Brook, New York, United States, 11794-9446
- Stony Brook University Cancer Center
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Syracuse, New York, United States, 13210
- SUNY Upstate Medical University Hospital
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke Cancer Institute
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Ohio
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Cleveland, Ohio, United States, 44195
- Cleveland Clinic Taussig Cancer Center
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Oklahoma
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Oklahoma City, Oklahoma, United States, 73142
- INTEGRIS Cancer Institute of Oklahoma - Proton Campus
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Oregon
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Portland, Oregon, United States, 97213-2967
- Providence Cancer Center at Providence Portland Medical Center
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Pennsylvania
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Monroeville, Pennsylvania, United States, 15146
- Forbes Regional Hospital
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Pittsburgh, Pennsylvania, United States, 15212
- Allegheny Cancer Center at Allegheny General Hospital
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Pittsburgh, Pennsylvania, United States, 15224-1791
- Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital
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Wynnewood, Pennsylvania, United States, 19096
- Lankenau Cancer Center at Lankenau Hospital
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Texas
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Houston, Texas, United States, 77030-4009
- M. D. Anderson Cancer Center at University of Texas
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Wisconsin
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Madison, Wisconsin, United States, 53792-6164
- University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
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Milwaukee, Wisconsin, United States, 53226
- Medical College of Wisconsin Cancer Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Eligibility Criteria:
- Histologic diagnosis of adenocarcinoma of the rectum (≤ 12 cm from the anal verge)
- T3, N0, M0, T1-3, N1-2, M0 disease as determined by pre-neoadjuvant therapy CT scans and pelvic MRI or transrectal ultrasound. Patients with T4 disease are not eligible.
- Completion of pre-operative 5FU based chemotherapy and/or radiation therapy. Capecitabine may be substituted for 5FU.
- Age ≥ 18 years
- ECOG (Zubrod) Performance Status ≤ 2
- Body Mass Index (BMI) ≤ 34
- No evidence of conditions that would preclude use of a laparoscopic approach (eg, multiple previous major laparotomies, severe adhesions)
No systemic disease (cardiovascular, renal, hepatic) that would preclude surgery. No other severe incapacitating disease:
- ASA IV: A patient with severe systemic disease that is a constant threat to life. OR
- ASA V: A moribund patient who is not expected to survive without the operation.
- No concurrent or previous invasive pelvic malignancy (cervical, uterine and rectal) within five years prior to registration
- No history of psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements.
NOTE: Incompetent patients are not eligible for this trial.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Arm 1: Open laparotomy and rectal resection
Patients undergo open laparotomy and rectal resection.
The standard form of surgery is open laparotomy rectal resection.
During open laparotomy, the surgeon makes a large incision or cut in the abdomen, and goes in through that cut to remove the tumor and lymph nodes from the rectum.
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Patients undergo open laparotomy and rectal resection.
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Experimental: Arm 2: Laparoscopic-assisted rectal resection
Patients undergo laparoscopic-assisted rectal resection.
Laparoscopic-assisted rectal resection is performed using small instruments on long handles introduced into the abdomen through small ports called trocars in 3 - 6 positions on the abdomen through incisions measuring 5 -10 mm, under the guidance of a video camera.
The abdominal wall is held up with carbon dioxide under pressure.
The piece of bowel or intestine is removed through another incision (about 8 centimeters), and the ends of the intestine are reconnected to provide normal bowel function.
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Patients undergo laparoscopic-assisted rectal resection.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparing Laparoscopic-assisted Resection to Open Rectal Resection for Rectal Cancer as Measured by the Percentage of Patients With Successful Resection Based on Pathological Evaluation.
Time Frame: At time of Surgery
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The primary endpoint will be a composite endpoint of oncologic factors which are indicative of an adequate surgical resection based on pathologic evaluation. Primary endpoint parameters:
All three criteria must be met for a resection to be deemed adequate. Laparoscopic-assisted resection will be compared to Open rectal resection to determine if it is non-inferior. |
At time of Surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Completeness of Total Mesorectal Excision (Complete or Nearly Complete)
Time Frame: At time of surgery
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Complete total mesorectal excision was defined as a rectal resection specimen having smooth surface of mesorectal fascia with all fat contained in the enveloping fascia to a level 5 cm below the tumor for tumor-specific total mesorectal excision for upper rectal cancer, or the entire mesorectal envelope present for low rectal cancer. Nearly complete was defined as a rectal resection specimen having the mesorectal envelope intact except for defects no more than 5 mm deep, with no loss of mesorectal fat. The percentage of patients with complete or nearly complete mesorectal excision was calculated along with the binomial 95% CI. |
At time of surgery
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Negative Distal Resected Margin
Time Frame: At time of surgery
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The percentage of patients with negative distal margin (>1 mm between the closest tumor to the cut edge of the tissue) was calculated along with binomial 95% confidence intervals.
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At time of surgery
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Circumferential Margin > 1 mm
Time Frame: At time of surgery
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The distance between the closest tumor to the cut edge of the tissue was measure post-resection.
The percentage of patients with >1mm between the closest tumor to the cut edge of the tissue was calculated with a binomial 95% confidence interval.
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At time of surgery
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Length of Stay
Time Frame: Two weeks post-surgery
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The mean number of days required post-surgery to the when the patient was released from the hospital was calculated.
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Two weeks post-surgery
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Use of Pain Medication
Time Frame: Two weeks post-surgery
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The number of days patients received parenteral narcotics post-surgery were counted.
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Two weeks post-surgery
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Operative Times
Time Frame: During surgery
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Open to close operative time.
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During surgery
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Disease-free Survival
Time Frame: Up to 2 years post surgery
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Up to 2 years post surgery
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Local Pelvic Recurrence Rates
Time Frame: Up to 2 years post surgery
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Up to 2 years post surgery
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Overall Survival
Time Frame: Up to 5 years post surgery
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Up to 5 years post surgery
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Quality of Life and Sexual Function
Time Frame: Up to 5 years post surgery
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Up to 5 years post surgery
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Bowel Function
Time Frame: Up to 5 years post surgery
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Up to 5 years post surgery
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Bowel and Stoma Function
Time Frame: Up to 5 years post surgery
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Up to 5 years post surgery
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Collaborators and Investigators
Collaborators
Investigators
- Study Chair: James W. Fleshman, MD, Baylor Health
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ACOSOG-Z6051
- U10CA076001 (U.S. NIH Grant/Contract)
- NCI-2009-00350 (Other Identifier: NCI Clinical Trial Reporting Office)
- CDR0000601816 (Registry Identifier: NCI Physician Data Query)
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.
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