National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study)

Category	Detail
Condition	Right-sided colon cancer (caecum, ascending colon, hepatic flexure, proximal transverse colon)
Key Mechanisms	Minimally invasive right hemicolectomy (MIRH) with complete mesocolic excision (CME) and central vascular ligation to remove tumour and draining lymph nodes with tumour-free margins
Target Population	Patients aged >18 years undergoing laparoscopic or robot-assisted right hemicolectomy for right-sided colon cancer
Care Setting	Multicentre surgical departments in the Netherlands performing minimally invasive colorectal surgery

Significant variation exists in MIRH techniques and surgical quality impacting oncological outcomes.
Standardisation and training in MIRH techniques aim to reduce postoperative complications and improve long-term survival.
The study implements a stepwise standardized MIRH technique validated by a competency assessment tool (CAT) and evaluates its impact on surgical quality and patient outcomes.

Include patients with colon cancer localized to caecum, ascending colon, hepatic flexure, or proximal transverse colon.
Exclude patients with cT4b/multivisceral resection, stage IV disease (M1), ASA 4, immune-modulating medication, large prior laparotomies, perforated disease, acute obstruction, emergency surgery, neuroendocrine neoplasm, or recent other primary malignancies.

Perform minimally invasive right hemicolectomy (laparoscopic or robot-assisted) with complete mesocolic excision and central vascular ligation.
Implement a standardized surgical technique developed by consensus (Delphi method) and supported by training and proctoring.
Aim for tumour-free margins and intact mesentery containing all tumour-draining lymph nodes.

Monitor 90-day postoperative complication rates to ensure safety of the standardized technique.
Assess surgical quality using a validated procedure-specific competency assessment tool (CAT).
Evaluate long-term oncological outcomes including 5-year overall survival and 3-year disease-free survival.

Potential variability in surgical quality due to surgeon experience and institutional factors.
Risk of increased postoperative complications if standardization and training are not properly implemented.
Exclusion of patients with advanced or complicated disease to minimize perioperative risks.

Adults undergoing minimally invasive right hemicolectomy for right-sided colon cancer without advanced or complicated disease.

Standardized MIRH technique aims to improve surgical quality and oncological outcomes without increasing short-term postoperative complications.

Adopt a standardized stepwise MIRH technique based on embryological planes and oncological principles.
Use low-pressure pneumoperitoneum, intracorporeal anastomosis, and optimal extraction site selection as part of the surgical approach.
Implement structured training, proctoring, and credentialing programs to reduce variability and improve surgical outcomes.
Utilize a validated competency assessment tool to objectively measure surgical quality and guide continuous improvement.
Conduct prospective data collection and follow-up to monitor safety and long-term effectiveness of the standardized technique.

Clinical Scorecard: Nationwide Adoption of a Standardized Approach for Right-Sided Colon Cancer: Protocol for an Interventional Sequential Cohort Study (Right Study)