Endoscopic Visualisation of Anastomosis in Colorectal Cancer Surgery (EVACCS)
Rectal Cancer, Colorectal Cancer, Anastomotic Leak
About this trial
This is an interventional prevention trial for Rectal Cancer
Eligibility Criteria
Inclusion Criteria:
- Over 18 years of age
- Undergoing colorectal resection involving the rectum
- Able to give informed consent to participate in trial
- American Society of Anesthesiologists (ASA) grade ≤ 3
Exclusion Criteria:
- Patients not undergoing colo-rectal/anal anastomosis e.g. abdominoperineal excision of rectum (APER), Hartmann's procedure.
- Patients undergoing synchronous colonic resections.
- Locally advanced rectal cancer requiring extended or multi-visceral excision.
- Recurrent rectal cancer
- Coexistent colorectal pathology e.g. synchronous cancers, inflammatory bowel disease.
- Previous pelvic radiotherapy for pathology unrelated to diagnosis with rectal cancer e.g. treatment for prostate cancer
- Patients who are pregnant
Sites / Locations
- University Hospitals Plymouth
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Intra-operative endoscopy
Standard air leak test
The intervention arm will have an intra-operative endoscopy performed per rectum once the anastomosis has been performed. The anastomosis will be graded from 1 to 3 in the endoscopic group. Grade 1 is defined as circumferentially normal appearing peri-anastomotic mucosa. Grade 2 is defined as ischemia or congestion involving <30% of either the colon or rectal mucosa. Grade 3 is defined as ischemia or congestion involving >30% of the colon or rectal mucosa or ischemia/congestion involving both sides of the staple line. If appearances are grade 2 a suture re-inforcement or re-anastomosis will be performed; if appearances are grade 3 a re-anastomosis will be performed. Images will be obtained via the endoscopy stack during the assessment.
The control arm will receive an intra-operative leak test. This involves insufflation of air per rectum via bladder syringe while the anastomosis is bathed in sterile water. The presence of air bubbles from the anastomosis denotes a positive test.