Standardization of the surgical technique and reporting for radical right colectomy with central vascular ligation and complete mesocolic excision (RRoC-STAR): Delphi consensus

Abstract

Background Complete mesocolic excision refers to a radical right hemicolectomy for cancer following embryologically defined anatomical planes. However, heterogeneity in definitions and techniques is a barrier to research. The aim of the Radical Right Colectomy - Surgical Technique Approved Report (RRoC-STAR) collaborative is to provide international expert consensus-based definitions and standardized terminology and surgical steps for right hemicolectomy for locally advanced colon cancer. Methods Authors of publications reporting on radical right hemicolectomy techniques were invited to complete an ACCORD-compliant Delphi questionnaire (two rounds). A standardized name (for the procedure) and a data sheet for reporting the procedure were proposed, along with 21 items, including terminology and surgical steps. The assembled panel was asked to vote for each item, with consensus considered to have been reached for items that achieved at least 80% agreement. Results Of 162 invited authors, 67 completed both Delphi rounds. All but 1 of the 21 items received consensus after 2 rounds. Consensus was reached on the use of the proposed data sheet for reporting, the term radical right colectomy (RRC), and the surgical steps deemed necessary for RRC, namely preservation of mesocolic integrity, sharp dissection of the anterolateral surface of the superior mesenteric vein up to the middle colic vein, ligation at the origin of vessels, and dissection of lymphoadipose tissue around the gastrocolic trunk of Henle. Conclusion This study provides an international expert consensus-based definition and standardization of terminology and the surgical steps required to perform RRC. A comprehensive data sheet for reporting RRC is introduced to enable data homogenization from current and future studies.