Neoplasms

Digestive System Diseases

All Conditions

Rare Diseases

Stomach Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Stomach Diseases

Stomach Cancer

After the proximal gastrectomy, the purse-string suture is tied at the esophagus stump, and the anvil head is inserted into the esophagus stump using an anvil clamp. A Roux-en-Y esophagojejunostomy (E-stomy) is performed by intracorporeal anastomosis with a circular stapler, and the jejunal stump is closed with a linear stapler. Next, side-to-side gastrojejunostomy (G-stomy), 15 cm below the E-stomy, is performed using 2 linear staplers. Finally, end-to-side jejunojejunostomy (J-stomy), 20 cm below the G-stomy, is performed by 2 linear staplers.

After the proximal gastrectomy, the purse-string suture is tied at the esophagus stump, and the anvil head is inserted into the esophagus stump using an anvil clamp. Next, end-to-end or side to end esophagogastrostomy is performed with a circular stapler.

Double tract anatomosis

Esophagogastrostomy

Xin Ji, M.D.

The patients with upper gastric cancer (cT1N0M0) or gastroesophageal adenocarcinoma (diameter less than 4 cm) will be enrolled into this study. Each of these patients will undergo radical proximal gastrectomy and be randomly allocated into one of the two groups, double tract anastomosis group or esophagogastrostomy group. The following data will be collected to compare the difference between the two reconstruction methods: the rate of reflux esophagitis, postoperative quality of life, economic expenditure, the safety of operation, postoperative recovery, postoperative nutrition status and oncological effect. Through the comprehensive analysis, the result of this study will elucidate the best of the reconstruction method after proximal gastrectomy.

Comparison Between Double Tract Anastomosis and Esophagogastrostomy After Radical Proximal Gastrectomy

Comparison Between Double Tract Anastomosis and Esophagogastrostomy After Radical Proximal Gastrectomy: A Prospective, Randomized, Controlled Study

The rate of reflux esophagitis after operation will be assessed by gastrointestinal endoscopy with Los Angeles (LA) classification. the degree of reflux esophagitis will be classified as N, A, B, C or D level, and latter levels represent a more severe reflux esophagitis.

Assessed by European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) - C30 questionnaire, the total score ranges from 30 to 126, and higher values represent a worse outcome.

Assessed by European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) - STO22 questionnaire, the total score ranges from 22 to 88, and higher values represent a worse outcome.

Peking University Cancer Hospital & Institute

Clinical Professor

Symptoms and General Pathology

Esophageal Neoplasms

Constriction, Pathologic

Head and Neck Neoplasms

Esophageal Diseases

Esophageal Cancer

hybrid everted esophagogastric anastomosis

the conventional hand-sewn anastomosis

a stapled anastomosis

Qi L Chen

The investigators improved the hybrid everted esophagogastrostomy and expected to prevent the incidence of anastomotic stricture. The purpose of this study is to determine the clinical value of this kind of operation type, and analyzes the clinicopathological factors causing the postoperative complications.

This randomized clinical trial compared a hybrid everted esophagogastric anastomosis with conventional hand-sewn or stapled esophagogastrostomy for prevention of anastomotic stricture. The patients were completely randomized to receive either a hybrid everted esophagogastric anastomosis (HE group), or the conventional hand-sewn (HS group), or a stapled (SA group) anastomosis, after the removal of esophageal tumor. The primary outcome measured the incidence of anastomotic stricture at 3 months after the operation (defined as the diameter of the anastomotic orifice \<= 0.8 cm on esophagogram), analyzed by intention-to-treat.

Hybrid-everted Versus Hand-sewn or Stapled Esophagogastrostomy in Prevention of Anastomotic Stricture

Phase III Study of Hybrid-everted Versus Hand-sewn of Stapled Esophagogastrostomy in Prevention of Anastomotic Stricture

the anastomotic stricture is defined as the diameter of the anastomotic orifice \<= 0.8 cm on esophagogram

0:No dysphagia on solid diet

1. dysphagia on solid diet
2. dyspahgia on semi-solid diet
3. dysphagia on fluid diet
4. dysphagia with water swallowing

0:no reflux on semi-supine position

1. postprandial reflux on semi-supine position
2. reflux with empty stomatch on semi-supine position
3. postprandial reflux on upright position
4. reflux with empty stomach on upright positino

Sichuan University

Long-Qi Chen, Professor

Ischemia

Anastomotic Leak

Postoperative Complications

Endoscopic examinations are performed at 1, 8, and 15 postoperative days. Endoscopic examination is added when abnormal findings are demonstrated.

Patients after esophagectomy

Shinichiro Kobayashi

Gastric conduit ischemia or anastomotic breakdown after esophagectomy with cervical esophagogastrostomy often cause severe complications, such as leakage, necrotic organs, and strictures. Thus, the purpose of this study is the safety and efficacy of endoscopic evaluation about reconstructive organs after esophagectomy. The investigators evaluate endoscopic predictions using classifications in acute phase after esophagogastrostomy.

Gastric conduit ischemia or anastomotic breakdown after esophagectomy with cervical esophagogastrostomy often cause severe complications, such as leakage, necrotic organs, and strictures. However the evaluation and prevention before developing gastric conduit ischemia have been established. The investigators have built a hypothesis that the evaluation for gastric mucosal ischemia in early phase after esophagectomy predict the complication of gastric conduit. Thus, the purpose of this study is the safety and efficacy of endoscopic evaluation about reconstructive organs after esophagectomy. The investigators evaluate endoscopic predictions using classifications in acute phase after esophagogastrostomy.

Endoscopic Evaluation After Esophagectomy

Endoscopic Evaluation for the Postoperative Condition After Esophagectomy and Reconstruction

The scoring system refer to the article entitled a scoring system for immunohistochemical staining: consensus report of the task force for basic research of the EORTC-GCCG. European Organization for Research and Treatment of Cancer-Gynaecological Cancer Cooperative Group (J Clin Pathol. 1997 Oct; 50(10): 801-804.)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Comparison Between Double Tract Anastomosis and Esophagogastrostomy After Radical Proximal Gastrectomy	NCT03613142	Gastric Cancer GastroEsophagea...	Double tract an... Esophagogastros...	18 Years - 80 Years	Peking University Cancer Hospital & Institute
Comparison Between Double Tract Anastomosis and Esophagogastrostomy After Radical Proximal Gastrectomy	NCT03613142	Gastric Cancer GastroEsophagea...	Double tract an... Esophagogastros...	18 Years - 80 Years	Peking University Cancer Hospital & Institute
Hybrid-everted Versus Hand-sewn or Stapled Esophagogastrostomy in Prevention of Anastomotic Stricture	NCT01139229	Esophageal Neop... Surgical Stomas	hybrid everted ... the conventiona... a stapled anast...	-	Sichuan University
Hybrid-everted Versus Hand-sewn or Stapled Esophagogastrostomy in Prevention of Anastomotic Stricture	NCT01139229	Esophageal Neop... Surgical Stomas	hybrid everted ... the conventiona... a stapled anast...	-	Sichuan University
Endoscopic Evaluation After Esophagectomy	NCT02703142	Esophageal Neop... Constriction Anastomotic Lea... Ischemia	Patients after ...	20 Years - 84 Years	Nagasaki University

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