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Gastric CancerNCT03500471

Robotic and Laparoscopic Total Gastrectomy With D2 Lymphadenectomy for Locally Advanced Gastric Cancer

An observational study of Gastric Cancer, run by Southwest Hospital, China at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is a prospective, single-center, non-randomized, controlled, non-blind, and non-inferiority observation trial comparing robotic-assisted total gastrectomy with D2 lymph nodal dissection for locally advanced gastric cancer patients with laparoscopic procedure. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Gastric Cancer
What is being tested?
Robotic-assisted Total Gastrectomy and Laparoscopic-assisted Total Gastrectomy
Type of treatment
Surgery or procedure
How many people
142 participants
Where
1 siteChina
Study dates
16 Apr 2018to 30 Aug 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients diagnosed with gastric cancer who need to received total gastrectomy with D2 lymphadenectomy.

Who may be able to join

  • Pathologically proven gastric adenocarcinoma;
  • Age: older than 18 years old, younger than 80 years old;
  • Tumor located in the upper third of the stomach or esophagogastric junction or other location, and is possible to be curatively resected by total gastrectomy;
  • Preoperative stage of cT2-4aN0-3M0 according to American Joint Committee on Cancer/Union for International Cancer Control 8th edition;
  • American Society of Anesthesiology (ASA) score of class I to III;
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1;
  • Patients who freely give informed consent to participate in the clinical study;

Who cannot join

  • Early gastric cancer;
  • Age: younger than 18 years old, older than 80 years old;
  • Total gastrectomy with D2 lymphadenectomy was not required;
  • Enlarged or bulky regional lymph node diameter larger than 3 cm based on preoperative imaging;
  • Emergency surgery for gastric cancer-related complications (bleeding or complete obstruction or perforation);
  • Previous upper abdominal surgery (except laparoscopic cholecystectomy);
Show all 13Show fewer
  • Previous neoadjuvant chemotherapy or radiotherapy for gastric cancer;
  • Unstable angina or myocardial infarction within the past 6 months;
  • Cerebrovascular accident within the past 6 months;
  • American Society of Anesthesiology (ASA) score of class more than III;
  • Severe respiratory disease (FEV1< 50%);
  • Continuous systemic steroid therapy within 1 month before the study;
  • Pregnant or breast-feeding women;

Trial locations and contacts

1 site in 1 country.

China1 site
  • Department of General Surgery and Center of Microinvasive Gastrointestinal Surgery,Southwest Hospital

    Chongqing, Chongqing Municipality, 400038

Other trials in China

About this study

Official title: Safety and Feasibility Between Robotic and Laparoscopic Total Gastrectomy With D2 Lymphadenectomy for Locally Advanced Gastric Cancer:A Prospective Cohort Study

This study is a prospective, single-center, non-randomized, controlled, non-blind, and non-inferiority observation trial comparing robotic-assisted total gastrectomy with D2 lymph nodal dissection for locally advanced gastric cancer patients with laparoscopic procedure.

Read the detailed description

Since Kitano firstly reported laparoscopy-assisted distal gastrectomy in 1994, the number of patients undergoing the laparoscopic procedure has gradually increased. The latest Japanese gastric cancer treatment guideline recommends laparoscopic gastrectomy (LG) as an optional treatment for cStage Ⅰ gastric cancer (GC).

Based on the experience of early GC, most experienced surgeons have applied the laparoscopic procedure in patients with locally advanced gastric cancer (AGC) especially in east world like China, Japan and Korea. Though applying laparoscopic-assisted total gastrectomy (LATG) is much more difficulty than that of distal gastrectomy (DG), there are a mount of centers reported their experiences of this procedure. A meta-analysis including seventeen studies of 2313 patients (955 in LATG and 1358 in open total gastrectomy) demonstrated that LATG can have less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. However, the number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar in both groups. According to the existing reports, LATG is technically safety and feasibility.

To overcome the limitations of laparoscopic surgery, robot systems have been introduced to treat GC providing technical advantages since Hashizume firstly reported. Yoon and Son respectively compared robot-assisted total gastrectomy (RATG) with LATG, they drew a common conclusion that the number of dissected lymph nodes and postoperative complications were similar in both groups. But Son found that the mean numbers of retrieved LNs along the splenic artery from RATG was higher than LATG (2.3 vs. 1.0, p = 0.013), as was also the case at the splenic hilum and artery (3.6 vs.1.9, p = 0.014). Regretfully, most of their reported cases were early gastric cancer (EGC). Other literatures reported AGC patients under RATG or LATG together with distal gastrectomy (DG), we haven't found any literature compare RATG with LATG alone for AGC retrospectively.

Since most literatures are EGC patients and retrospectively researches, we can't insist that patients with AGC may benefit under RATG. Therefore, we launch this prospective, single-center, non-randomized, controlled, non-blind, and non-inferiority observation trial comparing RATG for locally advanced gastric cancer patients with LATG.In the process of research,it will be divided into two groups according to the willing of patients or their legal representatives who choose one of the two procedures(RATG or LATG) to cure GC.The primary objective of this study is to assess whether RATG is comparable to laparoscopic approach in terms of overall postoperative morbidity rates. The secondary research objectives are to compare robotic with laparoscopic approach in terms of surgical outcomes, postoperative recovery courses.

Conditions
Gastric Cancer
Being tested
Robotic-assisted Total Gastrectomy, Laparoscopic-assisted Total Gastrectomy
Keywords
Laparoscopic, Robotic, Total Gastrectomy, AGC
Medical subject headings
Stomach Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Robotic-assisted Total GastrectomyProcedure or surgery

    Robotic-assisted total gastrectomy with D2 lymph node dissection will be performed with curative treated intent according to the patients' or their legal representatives'willing to choose robotic-assisted total gastrectomy and exclusing T4b、bulky lymph nodes or distant metastasis case by diagnostic laparoscopy. The alimentary canal reconstruction method is selected as esophageal jejunal R-Y anastomosis. Whether to reinforce the anastomotic manually is decided by the surgeon's experience. The reconstruction can be carried out by extracorporeal or intracorporeal anastomosis.

  • Laparoscopic-assisted Total GastrectomyProcedure or surgery

    Laparoscopic-assisted total gastrectomy with D2 lymph node dissection will be performed with curative treated intent according to the patients' or their legal representatives'willing to choose laparoscopic-assisted total gastrectomy and exclusing T4b、bulky lymph nodes or distant metastasis case by diagnostic laparoscopy. The alimentary canal reconstruction method is selected as esophageal jejunal R-Y anastomosis. Whether to reinforce the anastomotic manually is decided by the surgeon's experience. The reconstruction can be carried out by extracorporeal or intracorporeal anastomosis.

Study groups in NCT03500471
Study groupRoleWhat they receive
Experimental: Robotic surgeryRobotic-assisted Total Gastrectomy with D2 Lymphadenectomy
Receives: Procedure: Robotic-assisted Total Gastrectomy
Compared: Laparoscopic surgeryLaparoscopic-assisted Total Gastrectomy with D2 Lymphadenectomy
Receives: Procedure: Laparoscopic-assisted Total Gastrectomy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Overall postoperative morbidity and mortality

    Refers to the incidence of early postoperative complications. The early postoperative complication are defined as the event observed within 30 days after surgery.

    Measured: 30 days

Secondary outcomes (11)
  1. Time of operation

    The total time of operation

    Measured: 1 day

  2. Estimated blood loss

    Blood loss during intraoperative including the volume of negative pressure drainage bottle and the increasing weight of gauzes (ml)

    Measured: 1 day

  3. Blood transfusion

    Blood transfusion during operation

    Measured: 1 day

  4. Length of proximal and distal cutting margin

    Length of proximal and distal cutting margin of the specimen

    Measured: 1 day

  5. Number of retrieved lymph nodes

    Total number of harvested perigastric lymph node

    Measured: 7 days

  6. Time to flatus

    Time of anus exsufflation

    Measured: 30 days

  7. Time to first ambulation

    Time to walking about

    Measured: 30 days

  8. Time to liquid diet

    Time to liquid diet

    Measured: 30 days

  9. Time to soft diet

    Time to soft diet

    Measured: 30 days

  10. Duration of postoperative hospital stay

    Time from operation to hospital discharge

    Measured: 30 days

  11. cost

    All costs of hospitalization

    Measured: 30days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Apr 2018
  2. Study start16 Apr 2018
  3. Primary completion30 Aug 2021
  4. Study completion30 Aug 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
142 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03500471
Sponsor's protocol ID
20180108
Status last verified
Sep 2021
First submitted
28 Mar 2018
Last updated
21 Oct 2021
Results posted
No
Individual data sharing
No

Publications

  • Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017 Jan;20(1):1-19. doi: 10.1007/s10120-016-0622-4. Epub 2016 Jun 24. No abstract available.

    PubMed 27342689
  • Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc. 2013 May;27(5):1509-20. doi: 10.1007/s00464-012-2661-1. Epub 2012 Dec 14.

    PubMed 23263644
  • Etoh T, Honda M, Kumamaru H, Miyata H, Yoshida K, Kodera Y, Kakeji Y, Inomata M, Konno H, Seto Y, Kitano S, Hiki N. Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc. 2018 Jun;32(6):2766-2773. doi: 10.1007/s00464-017-5976-0. Epub 2017 Dec 7.

    PubMed 29218676
  • Yoon HM, Kim YW, Lee JH, Ryu KW, Eom BW, Park JY, Choi IJ, Kim CG, Lee JY, Cho SJ, Rho JY. Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc. 2012 May;26(5):1377-81. doi: 10.1007/s00464-011-2043-0. Epub 2011 Nov 16.

    PubMed 22083338
  • Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ. Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc. 2014 Sep;28(9):2606-15. doi: 10.1007/s00464-014-3511-0. Epub 2014 Apr 3.

    PubMed 24695982
  • Shen W, Xi H, Wei B, Cui J, Bian S, Zhang K, Wang N, Huang X, Chen L. Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc. 2016 Feb;30(2):574-580. doi: 10.1007/s00464-015-4241-7. Epub 2015 Jul 25.

    PubMed 26208497
  • Pan HF, Wang G, Liu J, Liu XX, Zhao K, Tang XF, Jiang ZW. Robotic Versus Laparoscopic Gastrectomy for Locally Advanced Gastric Cancer. Surg Laparosc Endosc Percutan Tech. 2017 Dec;27(6):428-433. doi: 10.1097/SLE.0000000000000469.

    PubMed 29211699
  • Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, Feng Q, Peiwu Y. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc. 2014 Jun;28(6):1779-87. doi: 10.1007/s00464-013-3385-6. Epub 2014 Jan 3.

    PubMed 24385251
  • Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS One. 2014 Feb 18;9(2):e88753. doi: 10.1371/journal.pone.0088753. eCollection 2014.

    PubMed 24558421

Questions about this trial

What is this clinical trial studying?

An observational study of Gastric Cancer, run by Southwest Hospital, China at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Overall postoperative morbidity and mortality (time frame: 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03500471, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Oct 2021.

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