Endoscopic Submucosal Dissection vs Local Laparoscopic Surgical Resection (TAMIS/TEO) in Early Rectal Neoplasias

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-01

Study Completion Date

2024-12-20

Brief Summary

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A multicenter non-inferiority randomized clinical trial to compare Endoscopic treatment (ESD) and Minimally Invasive Laparoscopic Local Surgical Treatment (TAMIS or TEO) for early rectal neoplastic lesions (adenoma \& T1CRC) Primary aim: To compare the long-term local recurrence rate (12 months after the procedure)

Secondary aims:

Compare en-bloq resection rate, R0 resection, time per procedure, short-term recurrence rate, safety (rate of complications), morbidity and cost-effectiveness analyses.

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Detailed Description

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A multicenter non-inferiority randomized clinical trial is proposed to compare two types of treatment for early rectal neoplastic lesions. Study arms:

1. Endoscopic treatment: Endoscopic Submucosal Dissection (ESD)
2. Minimally invasive laparoscopic local surgical treatment: Transanal Minimally Invasive Surgery (TAMIS) or Transanal Endoscopic Operation (TEO).

Aims:

Primary aim: To compare the long-term local recurrence rate (12 months after the procedure) of rectal lesions after ESD vs Surgical treatment (TAMIS/TEO).

Secondary aims: Both arms of the study are compared according to other efficacy-related variables (en-bloq resection rate, R0 resection, time per procedure, short-term recurrence rate \[6 months\]), safety (rate of complications), morbidity (comparing different specific indexes: Wexner index, EQ-5L-5D, etc) and cost-effectiveness analyses (QALY).

Inclusion criteria:

* Patients older than 18 y/o
* Non-pedunculated rectal lesions (sessile 0-Is or flat 0-II) greater than 20 mm in diameter.
* The edges of the lesion should be more than 3 cm from the external anal margin and up to 14 cm from it.
* Circumferential involvement \<50%

Exclusion criteria:

* Patients who refuse to participate.
* Diagnosis of inflammatory bowel disease with rectal involvement.
* Pregnant.
* Anorectal fibrosis due to previous anorectal surgery.
* Lateral Spreading Lesions (LST classification) Granular Homogeneous type
* Lesions greater than 50 mm when there is suspicion of advanced histology (Kudo Vi superficial pattern).
* Rectal lesions of any size with high suspicion of deep submucosal invasion or locoregional lymph node involvement, either in the diagnostic colonoscopy (Kudo Vn crypt pattern, NICE 3 pattern, Sano IIIB pattern) or by complementary imaging tests (rectal EUS/Pelvic MRI)
* Existence of synchronous colorectal lesions that require other surgical treatment in any case.

N-size estimation:

Assuming a global rate of long-term local recurrence in rectal lesions treated by TAMIS/TEO or ESD of 2.5% (using the data available in the medical literature), considering a non-inferiority limit of 10%, power of 80% (Beta error 0.2, alpha error 0.05) and assuming a loss of patients during the follow-up around 10%, 34 patients per group are required.

Follow-up and Information collect:

The follow-up will be of 1 year from the date of the intervention and the visits in which the information to be analyzed will be collected are adjusted to the usual clinical practice.

The data would be registered using the on-line database system for medical research RedCap.

Other information:

The entire protocol of this study has been approved by de Ethical Committee on Clinical Research of the Puerta de Hierro University Hospital.

The study counts with a Civil Responsibility Insurance policy.

Conditions

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Rectal Neoplasms

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Endoscopic Treatment

Rectal Endoscopic Submucosal Dissection

Group Type EXPERIMENTAL

ESD

Intervention Type PROCEDURE

Rectal Endoscopic Submucosal Dissection

Minimally Invasive Laparoscopic Local Surgical Treatment

Transanal Minimally Invasive Surgery (TAMIS) or Transanal Endoscopic Operation (TEO)

Group Type EXPERIMENTAL

TAMIS

Intervention Type PROCEDURE

Transanal Minimally Invasive Surgery

TEO

Intervention Type PROCEDURE

Transanal Endoscopic Operation

Interventions

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ESD

Rectal Endoscopic Submucosal Dissection

Intervention Type PROCEDURE

TAMIS

Transanal Minimally Invasive Surgery

Intervention Type PROCEDURE

TEO

Transanal Endoscopic Operation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients older than 18 y/o
* Non-pedunculated rectal lesions (sessile 0-Is or flat 0-II) greater than 20 mm in diameter.
* The edges of the lesion should be more than 3 cm from the external anal margin and up to 14 cm from it.
* Circumferential involvement \<50%

Exclusion Criteria

* Patients who refuse to participate.
* Diagnosis of inflammatory bowel disease with rectal involvement.
* Pregnant.
* Anorectal fibrosis due to previous anorectal surgery.
* Lateral Spreading Lesions (LST classification) Granular Homogeneous type
* Lesions greater than 50 mm when there is suspicion of advanced histology (Kudo Vi superficial pattern).
* Rectal lesions of any size with high suspicion of deep submucosal invasion or locoregional lymph node involvement, either in the diagnostic colonoscopy (Kudo Vn pit pattern, NICE 3 pattern, Sano IIIB pattern) or by complementary imaging tests (rectal EUS/Pelvic MRI)
* Existence of synchronous colorectal lesions that require other surgical treatment in any case.

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No