Current Studies

Current Studies

Preventing ovarian cancer through the expansion of opportunistic salpingectomy: Uptake, safety and cost-effectiveness at the time of colorectal surgery

Scope: This is an multi-site project studying the feasibility of performing opportunistic salpingectomy (the removal of the fallopian tubes) at the time of colorectal surgery to prevent ovarian cancer.

Background: Ovarian cancer is the 5th cause of cancer-related mortality in Canadian females. Opportunistic salpingectomy (OS) can prevent the most common and lethal type of ovarian cancer, the high grade serous carcinoma (HGSC). OS during gynecologic surgery (during hysterectomy or instead of tubal ligation) is safe and effective. However, rates of hysterectomies and tubal sterilization are decreasing. This study aims to extend the prevention of HGSC by expanding to offer OS during other surgeries in the pelvis where fallopian tubes are accessible, beginning with colorectal cancer.

Objective: This study aims to determine the feasibility, safety profile, and costs associated with performing OS at the time of colorectal surgery.   

Prospective analysis of postoperative morbidity, quality of life and functional outcome after Transanal Total Mesorectal Excision (TaTME Database)

Scope: This is an international, multi-site prospective registry that can capture results on TaTME procedures.

Background: TaTME is a relatively new surgical approach pioneered to tackle difficult pelvic dissections. This operation requires advanced surgical skills and transanal experience, and is currently not performed at every hospital. Its adoption is however rapidly increasing. Outcomes from any new procedure should be monitored and reviewed in order to ensure that the technique is introduced safely and does not lead to inappropriate patient harm. Hence the need for a registry that can capture results on TaTME from multiple centers around the world. This will allow more reliable analysis of larger patient series from the wider surgical community.  

Objective: The anticipated benefit of the TaTME database is to provide information of the benefits and potential risks associated with this technique in order to allow a more informed consenting process with the patients. Long-term results will also be analyzed with the aim of providing patients with better functional results and improved quality of life.

Neoadjuvant Chemotherapy, Excision and Observation for Early Rectal Cancer: The NEO Trial

Scope: To evaluate the use of neoadjuvant chemotherapy followed by minimally invasive local excision for patients with early stage rectal cancer.

Background: The current treatment for patients with early stage rectal cancer is a radical resection which involves removal of the rectum. This surgery, even when done laparoscopically, has significant rates of complications leading to ongoing issues of bowel function, incontinence, sexual function, and depression. Furthermore, preoperative radiation increases wound healing complications.The study explores the use of organ preservation for patients who show a tumor down staging to T0/T1 N0 to neoadjuvant chemotherapy. This can lead to better outcomes and higher quality of life. Currently there is no prospective experience of neoadjuvant chemotherapy and excision of early rectal tumors.

Objective: The primary objective of the NEO Trial is to determine the rate of organ preservation in patients with early rectal cancer treated with neoadjuvant chemoratherpy follow by local excision, defined as the proportion of paitents with tumor down staging to T0/T1 N0 to the number of patients who avoided radical resection. 

Non-operative Management for Locally Advanced Rectal Cancer: The NOM Study

Scope: To evaluate the safety of non-operative management (NOM) in patients with low rectal cancer who acheive a complete clicnical response following chemoradiotherapy.

Background: The standard treatment for low rectal cancer involving the anal sphincter is combined pre-operative chemotherapy and radiotherapy followed by surgery. Because of the high morbidtiy of surgery, there has been increasing interest in NOM of low rectal cancer. The NOM approach involves deferral of surgery and active surveillance of all low rectal cancer patients who achieved a complete clinical response following chemoradiotherapy, which occurs in approximately 20% of patients. To date, while there have been a few, prospective single institution studies that have shown favourable results with NOM, this approach has not been adopted into clinical practice due to concerns from physicians about the safety of NOM based on the limited evidence available. Furthermore, widespread adoption of NOM has the potential to increase health care capacity and decrease treatment costs by reducing the number of surgeries, hospital admissions and costs associated with both surgery and long term surgical morbidity.

Objective: This is a phase II study to evaluate the safety of NOM in low rectal cancer patients. There will be 90 participants across all sites.