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Stomach NeoplasmsNCT05890339

Laparoscopic Proximal Gastrectomy With Double-flap Technique Versus Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction for Proximal Early Gastric Cancer

A study testing Laparoscopic Proximal Gastrectomy With Double-flap Technique and Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction in people with Stomach Neoplasms, run by Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Proximal early gastric cancer can choose radical total gastrectomy or proximal gastrectomy. But if use simple esophagogastric anastomosis for proximal gastrectomy, the incidence of postoperative reflux esophagitis is up to 62%, which seriously affects the quality of life, and the short-term outcome is poorer than the… Read more about this study

Who is it for?
Ages 20 to 80 years
Conditions the study is for
Stomach Neoplasms
What is being tested?
Laparoscopic Proximal Gastrectomy With Double-flap Technique and Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
216 participants
Where
1 siteChina
Study dates
10 Jun 2023to 10 May 2033
Phase
Interventional
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • 20 years ≤ age ≤ 80 years
  • The primary gastric lesions were located in the proximal third of the stomach
  • histologically proven gastric adenocarcinoma (by preoperative gastrofiberscopy)
  • clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 8th edition of the American Joint Committee on Cancer(AJCC) staging system(Clinical stage was determined based on the finding of endoscopic ultrasonography and/or thoraco-abdominal contrast-enhanced computed tomography)
  • scheduled for laparoscopic proximal gastrectomy with D1+/D2 lymphadenectomy or laparoscopic total gastrectomy with D1+/D2 lymphadenectomy , and possible for R0 surgery by this procedures (Lymphadenectomy is performed on the basis of the criteria of the Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition).).
  • The preoperative American Society of Anesthesiologists (ASA) physical status was I-III; The patient's cardiopulmonary function can tolerate laparoscopic surgery.
  • The patients have signed the informed consent form.

Who cannot join

  • history of upper abdominal surgery (except laparoscopic cholecystectomy);
  • the tumor invades the esophagus 3cm above gastro-esophageal junction (Z-line)
  • with other malignant diseases or have suffered from other malignant diseases within 5 years
  • require simultaneous surgery due to complicated with other diseases
  • women are pregnant or in lactation period
  • Suffering from serious mental illness
  • history of continuous systemic corticosteroid or immunosuppressive drug treatment within 1 month

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Han Fanhai, Professor contact

+86-135-8031-7677

fh_han@163.com

China1 site
  • Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

    Guangzhou, Guangdong

Other trials in China

About this study

Official title: Laparoscopic Proximal Gastrectomy With Double-flap Technique Versus Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction for Proximal Early Gastric Cancer: a Multi-center Randomized Controlled Trial

Proximal early gastric cancer can choose radical total gastrectomy or proximal gastrectomy. But if use simple esophagogastric anastomosis for proximal gastrectomy, the incidence of postoperative reflux esophagitis is up to 62%, which seriously affects the quality of life, and the short-term outcome is poorer than the total gastrectomy. If the incidence of postoperative reflux esophagitis can be reduced, proximal gastrectomy would be the treatment choice for proximal early gastric cancer, which may more improve both quality of life and nutritional status than total gastrectomy.

Double-flap technique is a new surgical procedure for the reconstruction between esophagus and remnant stomach, which was started to be applied to digestive tract reconstruction in patients with proximal early gastric cancer in 2016. It can reduce the occurrence of reflux oesophagitis. At present, the studies for double-flap technique in China and other countries are mostly retrospective studies, and there are short of large-scale prospective studies and evidence of evidence-based medicine.

The applicant has initiated a phase II, single center, single arm study and the results suggested that the laparoscopic proximal gastrectomy with double-flap reconstruction technique was safe and effective for treating proximal early gastric cancer. To further validate the short and long-term outcomes of this procedure, a multicentre, open label, prospective, superiority and randomised controlled clinical trial was set up to compare laparoscopic proximal gastrectomy with double-flap technique with laparoscopic total gastrectomy with Roux-en-Y reconstruction for proximal early gastric cancer. It include 216 patients with proximal early gastric cancer. The primary outcome is the proportion of patients who develop reflux esophagitis within 12 months after surgery. The short and long-term oncological outcomes are also explored. This trial can provide high-grade evidence of evidence-based medicine for double-flap technique's clinical applications .

Being tested
Laparoscopic Proximal Gastrectomy With Double-flap Technique, Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction
Keywords
laparoscopy, minimally invasive surgical procedures, stomach neoplasm, Gastrectomy, Reflux Esophagitis
Medical subject headings
Stomach Neoplasms, Esophagitis, Peptic

What participants receive

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

  • Laparoscopic Proximal Gastrectomy With Double-flap TechniqueProcedure or surgery

    Patients in this group receive laparoscopic proximal gastrectomy with D1+/D2 lymph node dissection(D1+ for stage IA:Nos.1, 2, 3a, 4 sa, 4 sb, 7, 8a, 9, 11p;D2 for stage IB: Nos.1, 2, 3a, 4 sa, 4 sb, 7, 8a, 9, 11p and 11d). The double-flap technique is used for the esophagogastric reconstruction.

  • Laparoscopic Total Gastrectomy With Roux-en-Y ReconstructionProcedure or surgery

    Patients in this group receive laparoscopic total gastrectomy with D1+/D2 lymph node dissection(D1+ for stage IA:Nos.1, 2, 3, 4, 5, 6, 7, 8a, 9, 11p;D2 for stage IB: Nos.1, 2, 3, 4, 5, 6, 7, 8a, 9, 11p and 11d, 12a). The Roux-en-Y esophagojejunostomy method is used for the esophagojejunal reconstruction.

Study groups in NCT05890339
Study groupRoleWhat they receive
Laparoscopic Proximal Gastrectomy With Double-flap TechniqueExperimentalNot described
Receives: Procedure: Laparoscopic Proximal Gastrectomy With Double-flap Technique
Laparoscopic Total Gastrectomy With Roux-en-Y ReconstructionActive comparatorNot described
Receives: Procedure: Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction

What is being measured

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

  1. The Proportion of Patients With Reflux Esophagitis Within 12 Months Postoperatively

    During follow-up endoscopy 1 year after surgery, reflux esophagitis are graded according to the Los Angeles (LA) classification.

    Measured: 12 months postoperatively

Secondary outcomes (30)
  1. Quality of Life after Surgery

    Quality of life(QoL) is evaluated using the European Organization for Research and Treatment of Cancer (EORTC) 30-item core QoL (QLQ-C30 ver.3.0). Higher scores mean a worse outcome.

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively

  2. Gastrointestinal Symptoms after Surgery

    gastrointestinal symptoms are assessed by Gastrointestinal Quality of Life Index (GIQLI) questionnaires. Higher scores mean a better outcome.

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively

  3. Changes in hemoglobin levels at Follow-up

    blood hemoglobin(g/L) levels

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  4. Changes in Vitamin B12 levels at Follow-up

    blood Vitamin B12(μg/ml) levels

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  5. Changes in total protein levels at Follow-up

    blood total protein(g/L) levels

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  6. Changes in serum albumin levels at Follow-up

    blood serum albumin(g/L) levels

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  7. Changes in prealbumin levels at Follow-up

    blood prealbumin(g/L) levels

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  8. Late Postoperative Morbidity

    adhesive ileus, anastomosis stenosis, malnutrition, dumping syndrome. All postoperative complications are classified according to the Clavien-Dindo(CD) classification standard.

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  9. Early Postoperative Morbidity

    operation wound with seroma, hematoma, infection, dehiscence, or evisceration, anastomotic leakage, anastomotic bleeding, abdominal bleeding, abdominal abscess, intestinal obstruction morbidity, gastrointestinal bleeding, gastroparesis, postoperative pancreatitis, pancreatic fistula, chylous leakage, lung morbidity, cerebrovascular morbidity, cardiovascular morbidity, deep vein thrombosis, cholecystitis, liver dysfunction, kidney dysfunction. All postoperative complications are classified according to the Clavien-Dindo(CD) classification standard.

    Measured: From surgery to discharge, up to 30 days

  10. Short-term Clinical Outcome After Surgery

    time to pass gas(hours)

    Measured: From surgery to discharge, up to 30 days

  11. Short-term Clinical Outcome After Surgery

    time to oral intake(hours)

    Measured: From surgery to discharge, up to 30 days

  12. Short-term Clinical Outcome After Surgery

    time to indwell gastric tube(hours)

    Measured: From surgery to discharge, up to 30 days

  13. Short-term Clinical Outcome After Surgery

    length of postoperative hospitalisation(days)

    Measured: From surgery to discharge, up to 30 days

  14. Surgical Characteristics

    operative time(minutes)

    Measured: 24 hours postoperatively

  15. Surgical Characteristics

    time for reconstruction the digestive tract(minutes) during surgery

    Measured: 24 hours postoperatively

  16. Surgical Characteristics

    blood loss(ml) during surgery

    Measured: 24 hours postoperatively

  17. 3-year disease-free survival rate

    3-year disease-free survival rate

    Measured: 3 years

  18. 3-year overall survival rate

    3-year overall survival rate

    Measured: 3 years

  19. 3-year recurrence pattern

    3-year recurrence pattern

    Measured: 3 years

  20. 5-year disease-free survival rate

    5-year disease-free survival rate

    Measured: 5 years

  21. 5-year overall survival rate

    5-year overall survival rate

    Measured: 5 years

  22. 5-year recurrence pattern

    5-year recurrence pattern

    Measured: 5 years

  23. body mass index postoperatively

    body mass index(kg/m^2)

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively.

  24. Quality of Life postoperatively

    Quality of life(QoL) is evaluated using the European Organization for Research and Treatment of Cancer (EORTC) gastric cancer module (QLQ-STO22) questionnaire. Higher scores mean a worse outcome.

    Measured: Follow-up evaluations are performed 3, 6 and 12 months postoperatively

  25. Postoperative pain assessment

    We measured the pain score using visual analog scale(VAS) at 24 hours after the surgery is completed. Higher scores mean a worse outcome.

    Measured: Day 1 postoperatively

  26. Pathological Characteristics

    lymph nodes dissection extent for each patient in the surgery

    Measured: 1 week postoperatively

  27. Pathological Characteristics

    number of dissected lymph nodes for each patient in the surgery

    Measured: 1 week postoperatively

  28. Pathological Characteristics

    R0 resection rate. R0 resection represents complete resection of the tumor, meaning there is no residual tumor.

    Measured: 1 week postoperatively

  29. Proportion of participants die after surgery

    mortality rate

    Measured: From surgery to discharge, up to 30 days

  30. Proportion of participants need to rehospitalized after surgery

    rehospitalization rate.

    Measured: From surgery to discharge, up to 30 days

Timeline

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

  1. First posted6 Jun 2023
  2. Study start10 Jun 2023 (estimated)
  3. Primary completion10 Dec 2029 (estimated)
  4. Study completion10 May 2033 (estimated)

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
216 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05890339
Sponsor's protocol ID
SYSKY-2022-276-02
Status last verified
Sep 2022
First submitted
3 May 2023
Last updated
6 Jun 2023
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Zhou S, Xie Y, Zhu Y, Tan J, Yang B, Zhong L, Zhong G, Han F. Comparing the antireflux effect of laparoscopic proximal gastrectomy with double-flap technique reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for proximal early gastric cancer: study protocol for a multicentre, prospective, open-label, randomised controlled trial. BMJ Open. 2024 Jul 4;14(7):e079940. doi: 10.1136/bmjopen-2023-079940.

    PubMed 38964794

Questions about this trial

What is this clinical trial studying?

A study testing Laparoscopic Proximal Gastrectomy With Double-flap Technique and Laparoscopic Total Gastrectomy With Roux-en-Y Reconstruction in people with Stomach Neoplasms, run by Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University 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 7 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: opening soon, as of the sponsor's last update on 6 Jun 2023. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Han Fanhai, Professor (+86-135-8031-7677, fh_han@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Proportion of Patients With Reflux Esophagitis Within 12 Months Postoperatively (time frame: 12 months postoperatively). 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 NCT05890339, which also lists 1 linked publication.

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 6 Jun 2023.

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