Neoplasms

All Conditions

Digestive System Diseases

Rare Diseases

Adenocarcinoma

Stomach Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Stomach Diseases

Stomach Cancer

Lower Mediastinal Lymphadenectomy should be finished via laparoscopic method.

Lower Mediastinal Lymphadenectomy should be finished via open method.

Radical gastrectomy for gastric cancer should be consistent with Japanese gastric cancer treatment guideline.

Radical gastrectomy with dissection of lower mediastinal lymph node

Fei Shan, MD

Zhemin Li, MD

Mediastinal lymph node dissection has been adopted as standard treatment for adenocarcinoma of esophagogastric junction(AEJ). This multi-center, exploratory, prospective, cohort study aims at provide standard technical details of laparoscopic mediastinal lymph node dissection, and explore the potential clinical effects, gather key information for following study regarding sample size calculation, primary outcome and feasibility.

Introduction: Lower mediastinal lymph node dissection has been adopted as standard by treatment guideline for adenocarcinoma of esophagogastric junction(AEJ), but the effect of laparoscopic mediastinal lymph node dissection remains unknown. The aim of this study is to provide standard technical details of laparoscopic mediastinal lymph node dissection, and explore the potential clinical effects, gather key information for following study regarding sample size calculation, primary outcome and feasibility. This study report intervention development, governance procedures and selection and reporting of outcomes to optimize methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence-based practice.

Methods and analysis: This is an IDEAL stage II, prospective, parallel control, open label, multi-center and exploratory study. The inclusion criteria is Siewert II/ III, AEJ, cT2-4aN0-3M0(AJCC-8th Gastric Cancer TNM stage manual), decide to receive radical gastrectomy, without preoperative anti-neoplastic therapy. The individual included in the study is performed the radical total or proximal gastrectomy plus the lower mediastinal lymphadenectomy via either laparoscopic (trial arm) or open (control arm) TH approach. The surgical approach is determined by the investigator in each center before the operation and recorded in the electronic case report forms (CRF).

The primary outcome is the number of lower mediastinal lymph nodes retrieved. Secondary outcome include complication, surgery length, postoperative death, R0 resection rate, etc. Expected sample size is 518 in each group, thus has 80% power to detect a difference of 0.17 in the average number of lower mediastinal lymph node dissected in between two groups.

Laparoscopic Versus Open Lower Mediastinal Lymphadenectomy for Esophagogastric Junction Cancer

Laparoscopic Versus Open Lower Mediastinal Lymphadenectomy for Siewert Type II/III Adenocarcinoma of Esophagogastric Junction: an Exploratory, Prospective, Observational, IDEAL Stage 2, Cohort Study

De-identified data will be shared after the publication of the results.

surgical characteristics that are directly related to the safety outcome of surgery

refers to the number of surgical cases corresponding to the transition point

the proportion of persons willing to receive treatment in randomization

The number of patients that can be screened, excluded, successfully recruited, intervented, and followed up throughout each phase of the study.

The number of lower mediastinal lymph nodes retrieved

Complication during Lower Mediastinal Lymphadenectomy \& anastomosis, including damage of pericardium, esophagus, etc.

Postoperative complication after Lower Mediastinal Lymphadenectomy, including leakage, bleeding, etc, complication related with Lower Mediastinal Lymphadenectomy

Time length of Lower Mediastinal Lymphadenectomy

Any complication within 30d after surgery

unscheduled readmission within 30 days after surgery

from proximal tumor margin to proximal margin

Local recurrence of lower mediastinal area in 3 years

Spots Global Cancer Trial Database for lower mediastinal lymphadenectomy