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The patients in DS group underwent Delta-shaped anastomosis after TLDG.

The patients in B-II group underwent Billroth-II anastomosis after TLDG.

Delta-shaped anastomosis

Billroth II anastomosis

Quan Wang, Doctor

To compare the safety and feasibility of Delta-shaped anastomosis and Billroth II anastomosis after totally laparoscopic distal gastrectomy for gastric cancer(TLDG).

Methods: 78 consecutive patients who underwent TLDG in First Hospital of Jilin University between October 2012 and December 2014 were enrolled in this study . All patients were divided randomly into two groups:Delta-shaped anastomosis group (DS group) and Billroth II anastomosis group (B-II group), and the patients in DS group underwent Delta-shaped anastomosis after TLDG, and the patients in B-II group underwent Billroth-II anastomosis after TLDG.Outcome measures,resected margin,operative time,anastomosis time,number of stapler cartridges used,length of the incision,the time of first flatus and liquid diet,hospital stay and postoperative morbidity are compared between the two groups.

Comparison of Delta-Shaped and Billroth II After TLDG

Comparison of Delta-Shaped and Billroth II for Intracorporeal Anastomosis After Totally Laparoscopic Distal Gastrectomy for Gastric Cancer

Major complications includes anastomosis leakage and intrabdominal bleeding . Minor complications includes bile regurgitation,anastomotic stenosis and delayed gastric emptying.

The First Hospital of Jilin University

Deputy Director of General Surgery

Indocyanine Green Tracer will be used in laparoscopic distal gastrectomy with lymph node dissection for gastric adenocarcinoma.

Laparoscopic distal gastrectomy with lymph node dissection for early gastric cancer using Indocyanine Green Tracer

Indocyanine Green

Chang-Ming Huang, MD

Zu-Kai Wang, MD

Chang-Ming Huang, Huang

This study aims to explore the value of indocyanine green (ICG) in laparoscopic distal gastrectomy with lymph node dissection for early gastric cancer.The patients with early gastric adenocarcinoma (cT1, N-/+, M0) will be studied.

After being informed about the study and potential risks, all patients giving written informed consent will receiving injection of indocyanine greenat 8 points around the primary tumor with gastroscope 1 day before surgery. During the operation, laparoscopic gastrectomy and perigastric lymph node dissection were performed under ICG imaging equipment. After the surgical specimens were isolated, under the fluorescent illumination of the ICG imaging equipment, the lymph nodes that showed fluorescence and the lymph nodes that did not show fluorescence were collected from each LN station.

Indocyanine Green Tracer Using in Laparoscopic Distal Gastrectomy for Early Gastric Cancer

Prospective Clinical Trials on Clinical Outcomes of Indocyanine Green Tracer Using in Laparoscopic Distal Gastrectomy With Lymph Node Dissection for Early Gastric Cancer

The number of positive lymph nodes in not fluorescent lymph nodes is divided by the number of total not fluorescent lymph nodes

The number of positive lymph nodes in fluorescent lymph nodes is divided by the number of total fluorescent lymph nodes

The number of negative lymph nodes in fluorescent lymph nodes is divided by the number of total fluorescent lymph nodes

The number of negative lymph nodes in not fluorescent lymph nodes is divided by the number of total not fluorescent lymph nodes

Lymph node noncompliance was defined as the absence of lymph nodes that should have been excised from more than 1 lymph node station. Major lymph node noncompliance was defined as more than 2 intended lymph node stations that were not removed.

This is for the early postoperative complication and mortality, which defined as the event observed within 30 days after surgery.

Recurrence patterns are classified into five categories at the time of first diagnosis: locoregional, hematogenous, peritoneal, distant lymph node, and mixed type.

The intraoperative postoperative morbidity rates are defined as the rates of event observed within operation.

Time to first ambulation in hours is used to assess the postoperative recovery course.

Time to first flatus in days is used to assess the postoperative recovery course.

Time to first liquid diet in days is used to assess the postoperative recovery course.

Time to first soft diet in days is used to assess the postoperative recovery course.

Duration of postoperative hospital stay in days is used to assess the postoperative recovery course.

The values of white blood cell count from peripheral blood before operation and on postoperative day 1, 3, 5 are recorded to access the inflammatory and immune response.

The values of hemoglobin in gram/liter from peripheral blood before operation and on postoperative day 1, 3, 5 are recorded to access the inflammatory and immune response.

Fujian Medical University

Professor

Herbal and Botanical

All Drugs and Chemicals

Cola

An incision of 15\~20 cm length is made in the abdominal midline . Standard distal gastrectomy and omentectomy will be performed with D2 lymph node dissection (around common hepatic artery, celiac artery, proximal part of splenic artery, proper hepatic artery) . As a general rule, Billroth I, Billroth II or Roux en Y method was used for gastric reconstruction.

5 trocar were used. The gastrocolic ligament was divided along the border of the transverse colon. ligating the left gastroepiploic vessels to remove group 4sb.

The right gastroepiploic vein was divided and the right gastroepiploic and the inferior pyloric artery were vascularized and cut at their origin from the gastroduodenal artery, just above the pancreatic head, to dissect group 6.

The dissection was continued along the hepatoduodenal ligament to removed group 5 and group 12a and along the common hepatic artery to remove group 8a and along the celiac axis to remove group 9.

The left gastric vein was prepared and separately divided and then the left gastric artery was vascularized to remove group 7.

The dissection was continued upward along the proximal branches of splenic vessels to remove group 11p and along the lesser curvature to remove group 1,3.

As a general rule, Billroth I, Billroth II or Roux en Y method was used for gastric reconstruction.

Distal gastrectomy and standard D2 lymphadenectomy

Laparoscopic distal gastrectomy

Long D. Vo, MD PhD.

There are more than 75% of patients with gastric cancer who are diagnosed in advanced stage in Vietnam, most of cases in T4a. The purpose of this study was to compare short- and long- term outcomes of open and laparoscopic distal gastrectomy for gastric adenocarcinoma in surgical T4A stage.

Gastric cancer is one of the most common cancers in Vietnam . Despite recent advances in multimodality treatment and targeted therapy, surgery remains the first option of treament for this disease. For resectable gastric cancer, complete removal of macroscopic and microscopic lesions and/or combined resections and also regional or extended lymphadenectomy should represent worldwide now.

Laparoscopic gastrectomy for locally advanced gastric cancer AGC have commonly used for treatment of AGC, especially in Japan, Korea and China. However, the real role of laparoscop for treament of (AGC) is still controversial in term of technical feasibility, safety and oncologic aspect for T4a stage.

Paragastric inflammatory strands may occur in T4a tumor so that laparoscopic technique is difficult to radically perform. Peritoneal seeding of malignant cells, intra- and postoperative complications, trocarts metastasis may risk during procedures. Despite, some studies have demonstrated the safety and the short-term benefits of LG for T4a gastric cancer, the number of these studies and sample sizes have been still inadequate to give good evidence for applying it. and long-term oncologic outcomes There are more than 75% of patients with gastric cancer who are diagnosed in advanced stage in Vietnam, most of cases in T4a. The purpose of this study was to compare short- and long- term outcomes of open and laparoscopic distal gastrectomy for gastric adenocarcinoma in surgical T4A stage.

Long-term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer

Long-term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer: a Propensity Score-matched Cohort Study

The percentage of people in this study who are alive five years after surgery.

The percentage of people in this study who are alive without recurrence/metastasis five years after surgery.

The percentage of people in this study who are alive one years after surgery.

The percentage of people in this study who are alive without recurrence/metastasis one years after surgery.

The overall rate of postoperative complications

The duration of a surgical procedure in minutes.

The amount of blood lost during procedure

Number of days from date of surgery until date of flatus

Number of days from date of surgery until date of discharge or mortality

The percentage of complication grade by Clavien-Dindo classification

The percentage of pattern of recurrence/metastasis during follow up period

University Medical Center Ho Chi Minh City (UMC)

Robotic Distal Gastrectomy will be performed for the treatment of patients assigned to this group.

Laparoscopic Distal Gastrectomy will be performed for the treatment of patients assigned to this group.

After exclusion of T4b, bulky lymph nodes, or distant metastasis case, robotic distal gastrectomy will be performed in the experimental group.

Robotic Distal Gastrectomy

After exclusion of T4b, bulky lymph nodes, or distant metastasis case, laparoscopic distal gastrectomy will be performed in the comparator group.

Laparoscopic Distal Gastrectomy

Changming Huang, Professor

The purpose of this study is to explore the clinical outcomes of the robotic distal gastrectomy for patients with gastric adenocarcinoma（cT1-4a, N-/+, M0）.

Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The study is designed to explore the clinical outcomes of the robotic distal gastrectomy by comparing short- and long-term outcomes including financial cost of robotic and laparoscopic distal gastrectomy in the treatment of gastric adenocarcinoma （cT1-4a, N-/+, M0）.

Clinical Outcomes of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer

Randomized Controlled Trials on Clinical Outcomes of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer

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

Refers to the incidence of early postoperative complication which is graded as Clavien-Dindo IIIA or higher

the noncompliance rate of lymphadenectomy

The variation of weight in kilograms on postoperative 3, 6, 9 and 12 months are used to access the postoperative nutritional status.

The variation of cholesterol in millimole/liter on postoperative 3, 6, 9 and 12 months are used to access the postoperative nutritional status.

The variation of album in gram/liter on postoperative 3, 6, 9 and 12 months are used to access the postoperative nutritional status.

The values of white blood cell count from peripheral blood before operation and on postoperative day 1, 5 are recorded to access the inflammatory response.

The values of hemoglobin in gram/liter from peripheral blood before operation and on postoperative day 1, 5 are recorded to access the inflammatory response.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Comparison of Delta-Shaped and Billroth II After TLDG	NCT02372747	Gastric Cancer	Delta-shaped an... Billroth II ana...	-	The First Hospital of Jilin University
Indocyanine Green Tracer Using in Laparoscopic Distal Gastrectomy for Early Gastric Cancer	NCT04973475	Early Gastric C... Indocyanine Gre... Lymph Node Diss...	Indocyanine Gre...	18 Years - 75 Years	Fujian Medical University
Indocyanine Green Tracer Using in Laparoscopic Distal Gastrectomy for Early Gastric Cancer	NCT04973475	Early Gastric C... Indocyanine Gre... Lymph Node Diss...	Indocyanine Gre...	18 Years - 75 Years	Fujian Medical University
Long-term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer	NCT05493358	Gastric Cancer	Laparoscopic di...	15 Years - 90 Years	University Medical Center Ho Chi Minh City (UMC)
Clinical Outcomes of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer	NCT03313700	Stomach Neoplas... Robotic Surgery	Robotic Distal ... Laparoscopic Di...	18 Years - 75 Years	Fujian Medical University
Long-term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer	NCT05493358	Gastric Cancer	Laparoscopic di...	15 Years - 90 Years	University Medical Center Ho Chi Minh City (UMC)

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