{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:47:26Z","timestamp":1790027246136,"version":"4.0.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In minimally invasive surgery of the sigmoid colon and rectum a retractor sponge has been introduced as an alternative to the Trendelenburg position. This randomized clinical trial (RCT) compared postoperative duration of hospital stay and perioperative outcomes in patients with sigmoid or rectal cancer undergoing sponge-assisted versus Trendelenburg position surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The SPONGE trial is a single-centre RCT nested within the Dutch nationwide prospective observational cohort of patients with colorectal cancer, and follows the Trials within Cohorts (TwiCs) design. Patients with sigmoid or rectal cancer undergoing elective laparoscopic or robotic surgery were randomized to either sponge-assisted or Trendelenburg surgery on a 1:1 basis using block randomization. Duration of postoperative hospital stay was the primary outcome and was compared using the Mann\u2013Whitney U test. Secondary endpoints included the proportion of complications, readmissions, or mortality versus the \u03c72 test in intention-to-treat and per-protocol analyses. This trial was not blinded for patients in the intervention arm or physicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between November 2015 and June 2021, 82 patients were randomized to sponge-assisted surgery and 81 to Trendelenburg surgery. After post-randomization exclusion, 150 patients remained for analyses (75 patients per arm). There was no statistically significant difference in median duration of hospital stay (5 days versus 4 days, respectively; P = 0.06), 30-day postoperative complications (30 per cent versus 31 per cent; P = 1.00), readmission rate (8 per cent versus 15 per cent; P = 0.30), or mortality (0 per cent versus 1 per cent, P = 1.00). The per-protocol analysis showed similar results. No adverse device events were seen.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Sponge-assisted laparoscopic\/robotic surgery does not reduce the duration of hospital stay, or perioperative morbidity or mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>NCT02574013 (http:\/\/www.clinicaltrials.gov)<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znac249","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T10:48:52Z","timestamp":1664966932000},"page":"1081-1086","source":"Crossref","is-referenced-by-count":10,"title":["SPONGE-assisted <i>versus<\/i> Trendelenburg position surgery in laparoscopic sigmoid and rectal cancer surgery (SPONGE trial): randomized clinical trial"],"prefix":"10.1093","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6662-4604","authenticated-orcid":false,"given":"Milad","family":"Fahim","sequence":"first","affiliation":[{"name":"Department of Value-Based Healthcare, St. Antonius Hospital , Nieuwegein , The Netherlands"},{"name":"Department of Surgery, St. Antonius Hospital , Nieuwegein , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Couwenberg","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, The Netherlands Cancer Institute , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike E","family":"Verweij","sequence":"additional","affiliation":[{"name":"Division of Imaging and Oncology, University Medical Center Utrecht , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea M","family":"Dijksman","sequence":"additional","affiliation":[{"name":"Department of Value-Based Healthcare, St. Antonius Hospital , Nieuwegein , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena M","family":"Verkooijen","sequence":"additional","affiliation":[{"name":"Division of Imaging and Oncology, University Medical Center Utrecht , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke B","family":"Smits","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Antonius Hospital , Nieuwegein , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,1]]},"reference":[{"key":"2023063011123641800_znac249-B1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.7150\/jca.3621","article-title":"A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer","volume":"3","author":"Ohtani","year":"2012","journal-title":"J Cancer"},{"key":"2023063011123641800_znac249-B2","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s00384-016-2506-9","article-title":"Laparoscopic versus open surgery for rectal cancer: a meta-analysis of 3-year follow-up outcomes","volume":"31","author":"Zhao","year":"2016","journal-title":"Int J Colorectal Dis"},{"key":"2023063011123641800_znac249-B3","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.ejso.2018.06.001","article-title":"Achievements in colorectal cancer care during 8 years of auditing in the Netherlands","volume":"44","author":"de Neree tot Babberich","year":"2018","journal-title":"Eur J Surg Oncol"},{"key":"2023063011123641800_znac249-B4","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1007\/s00464-009-0785-8","article-title":"Impact of the patient\u2019s body position on the intraabdominal workspace during laparoscopic surgery","volume":"24","author":"Mulier","year":"2010","journal-title":"Surg Endosc"},{"key":"2023063011123641800_znac249-B5","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/anae.12477","article-title":"Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic-assisted prostatic surgery","volume":"69","author":"Schramm","year":"2014","journal-title":"Anaesthesia"},{"key":"2023063011123641800_znac249-B6","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1213\/ANE.0b013e3182075d1f","article-title":"Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45\u00b0 Trendelenburg position","volume":"113","author":"Lestar","year":"2011","journal-title":"Anesth Analg"},{"key":"2023063011123641800_znac249-B7","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10151-012-0879-5","article-title":"Raised intraocular pressure (IOP) and perioperative visual loss in laparoscopic colorectal surgery: a catastrophe waiting to happen? 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