Neoplasms

All Conditions

Adenocarcinoma

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Double tract reconstruction would be applied after proximal gastrectomy

Gastric conduit reconstruction would be applied after proximal gastrectomy

Other reconstructions except for double tract and gastric conduit reconstructions would be applied after proximal gastrectomy

Double tract reconstruction would be applied after radical proximal gastrectomy.

Double tract reconstruction

Gastric conduit reconstructionn would be applied after radical proximal gastrectomy.

Gastric conduit reconstruction

Other reconstructions except for double tract and gastric conduit reconstructions would be applied after radical proximal gastrectomy.

Other reconstructions

Ping Shu, PHD

This study is designed as a prospective, real world registry study that compare the safety and efficacy of the different construction methods after radical proximal gastrectomy.

* The patient was admitted to the hospital, and at the time of physical examination, the following conditions were met: 18 years old ≤ age ≤ 80 years old; preoperative ECOG performance status score 0/1; non-pregnant or lactating women; no serious mental illness; no serious respiratory disease; No severe hepatic and renal insufficiency; no history of unstable angina pectoris and myocardial infarction within 6 months; no history of cerebral infarction or cerebral hemorrhage within 6 months, except for old cavity infarction; no history of continuous glucocorticoid therapy (local Except for applications); pulmonary function test showed FEV1 ≥ 50% of the predicted value. The patient did not participate in other clinical studies (within 6 months).

  * gastric adenocarcinoma was diagnosed by endoscopic examination and histopathological biopsy of the patient's primary lesion, including: papillary adenocarcinoma, tubular adenocarcinoma, mucinous adenocarcinoma, poorly adherent carcinoma (including signet ring cell carcinoma and other types), Mixed adenocarcinoma, etc. In qualified units, endoscopic ultrasonography (EUS) is recommended. The tumor is located in the upper part of the stomach or at the esophagogastric junction (tumor diameter is less than 4cm, and the length of invasion of the esophagus is less than 2cm);

    * Enhanced CT scan of the abdomen and pelvis was performed on the patient. For upper gastric cancer, no tumor invading the muscular layer, subserosal layer or serosa layer was found, and no distant metastasis occurred; for esophagogastric junction cancer, no distant metastasis occurred;

      * The patient has a clear diagnosis of gastric adenocarcinoma, and it is expected that proximal gastrectomy and lymph node dissection can be performed to obtain an R0 surgical result. .

        * The patient's ASA is I-III. ⑥ At this point, the patient becomes a potential selected case and enters the case selection procedure.

A Prospective Observation Registry Study on the Alimentary Reconstruction After Radical Proximal Gastrectomy

Reflux esophagitis refers to esophageal erosions and/or esophageal ulcers caused by the reflux of esophageal contents into the esophagus or above (oral mouth, throat, lungs) causing complaints of discomfort and endoscopic manifestations of esophageal mucosal defects.

Take the total number of patients receiving surgical treatment as the denominator, and the number of patients with intraoperative/postoperative early and late complications during any one and follow-up as the numerator to calculate the proportion;

Body weight(kg)would be monitored during follow-up after surgery.

Albumin(g/L) would be monitored during follow-up after surgery.

Hemoglobin(g/L) would be monitored during follow-up after surgery.

The time between the date of surgery as the starting point and the date of tumor recurrence as the ending point (or the date of death due to tumor cause when the exact date of tumor recurrence is not known).

When neither death nor tumor recurrence was observed at follow-up, the final date of confirmation of recurrence-free survival (final recurrence-free survival confirmation date: the last of the date of the outpatient visit or the date of the examination received) was used.

Taking the total number of patients receiving surgical treatment as the denominator, and observing any of the following patients as the numerator, the ratio calculated as the surgical death ratio:

1. According to the observation items during the operation and the observation items after the operation, it will be recorded as death;
2. All patients who died from the start of the operation to within 30 days after the operation (including 30 days) (regardless of whether the cause of death was causally related to the operation);
3. In a longer period of time after 31 days after the operation, there is definite evidence that the death of the patient has a direct causal relationship with the first operation.

Shanghai Zhongshan Hospital

Digestive System Diseases

Ear, Nose, and Throat Diseases

Rare Diseases

Gastroesophageal Reflux

Stomach Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Stomach Diseases

Esophageal Motility Disorders

Esophageal Spasm, Diffuse

Deglutition Disorders

Esophageal Diseases

Stomach Cancer

The reconstruction including esophagogastric anastomosis and pyloroplasty for patients who underwent proximal gastrectomy . The anastomosis locate in the anterior of gastric stump.

The reconstruction including esophagogastric anastomosis and pyloroplasty for patients who underwent proximal gastrectomy . The anastomosis locate in the posterior or side of gastric stump.

The location of the anastomosis in the anterior of the gastric stump. Pyloroplasty is added in the procedure

Proximal Gastrectomy Anterior Anastomosis With Pyloroplasty

Yunhong Tian, PHD

This research is designed to compare proximal gastrectomy anterior anastomosis with pyloroplasty with esophagogastric anastomosis for gastric cancer. Gastroesophageal reflux disease, postoperative quality of life, short term outcomes, and long term outcomes will be compared.

Proximal Gastrectomy Anterior Anastomosis With Pyloroplasty Versus Esophagogastric Anastomosis for Gastric Cancer

Surgical complications include anastomotic leakage, anastomotic stricture, postoperative bleeding, pleural effusion, et al.

Total survival time after proximal gastrectomy for gastric cancer

Nanchong Central Hospital

Professor

In this arm, patients will receive proximal gastrectomy and "arch-bridge-type" reconstruction.

1. The lymphadenectomy is performed according to the Japanese Gastric Cancer Treatment Guidelines
2. Transection of the esophagus is performed using a linear stapler 2cm away from the proximal end of the tumor.
3. Creating the seromuscular flap ("arch-bridge")
4. The remnant stomach is then inserted into the abdominal cavity, and pneumoperitoneum is re-established to perform the intracorporeal anastomosis.

"arch-bridge-type" esophagogastric reconstruction after proximal gastrectomy

Yinkui Wang, MD PHD

Ziyu Li, MD PHD

Ziyu Li, M.D.

Fei Shan, M.D.

Yinkui Wang, M.D.

The double-flap technique (DFT) is an effective digestive tract reconstruction method after proximal gastrectomy (PG) to reduce the incidence of postoperative reflux esophagitis. But its clinical application is restricted due to the technical complexity. Our surgical team devise a modified esophagogastric reconstructive method which we term the "arch-bridge-type" reconstruction based on the principle of DFT. The aim of this single-arm prospective study is to assess the safety and feasibility of the "arch-bridge-type" reconstruction after PG.

1. The lymphadenectomy is performed according to the Japanese Gastric Cancer Treatment Guidelines.
2. Transection of the esophagus is performed using a linear stapler 2cm away from the proximal end of the tumor.
3. Creating the seromuscular flap ("arch-bridge"):

(1) The stomach is resected by a linear stapling device. (2) A "匚" shaped seromuscularflap (3.0cm×4.0cm) is created utilizing electrocautery extracorporeally by dissecting submocosal and muscular layer of the anterior wall of the remnant stomach.

(3) The opening of the flap is interrupted sutured by 4-0 absorbable suture, then the "arch-bridge" is created.

4.The remnant stomach is then inserted into the abdominal cavity, and pneumoperitoneum is re-established to perform the intracorporeal anastomosis.

A Modified Esophagogastric Reconstruction Method After Laparoscopic Proximal Gastrectomy

A Modified "Arch-bridge-type" Esophagogastric Reconstruction Method After Laparoscopic Proximal Gastrectomy

The incidence of postoperative complications which were graded using the Clavien-Dindo classification system. The postoperative complications include anastomotic leackage, anastomotic stenosis, abdominal bleeding, gastric emptying disorder, pneumonia complications, etc.

The QoL is evaluated by postgastrectomy symptom assessment scale (PGSAS-45). Postoperative reflux, abdominal pain, postprandial discomfort, dyspepsia, diarrhea, constipation, dumping syndrome, weight change, food intake per meal, frequency of additional meals, digestive ability, daily work ability, and satisfaction with quality of life will be evaluated in PGSAS-45.

Body weight loss will be recorded in outpatient.

Reflux esophagitis will be evaluated by gastroscopy. Reflux esophagitis was graded by the Los Angeles classification.

During the operation, the whole process of the operation will be videotaped by laparoscopy, and after the operation, the change of the technical process of the operation was judged by comparing the operation in the video and the scheduled operation steps before the operation. In case of technical changes, the surgical team will communicate and discuss with the chief surgeon, and decide whether to adjust and optimize the surgical technique based on the postoperative situation of the patient, so as to form new technical details. Objective metrics include the total operative time, the time of esophagogastric anastomosis, the time of creating the" arch-bridge", intraoperative blood loss, the number of retrieved lymph nodes will be collected.

Laboratory tests will be done to evaluate the level of hemoglobin.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
A Prospective Observation Registry Study on the Alimentary Reconstruction After Radical Proximal Gastrectomy	NCT05539105	Proximal Gastri... Reconstruction	Double tract re... Gastric conduit... Other reconstru...	18 Years - 80 Years	Shanghai Zhongshan Hospital
Proximal Gastrectomy Anterior Anastomosis With Pyloroplasty Versus Esophagogastric Anastomosis for Gastric Cancer	NCT05514769	Proximal Gastri... Gastric Cancer Gastroesophagea...	Proximal Gastre...	18 Years - 85 Years	Nanchong Central Hospital
A Modified Esophagogastric Reconstruction Method After Laparoscopic Proximal Gastrectomy	NCT05829213	Proximal Gastri... Adenocarcinoma ... Anastomosis	"arch-bridge-ty...	18 Years - 75 Years	Peking University
A Modified Esophagogastric Reconstruction Method After Laparoscopic Proximal Gastrectomy	NCT05829213	Proximal Gastri... Adenocarcinoma ... Anastomosis	"arch-bridge-ty...	18 Years - 75 Years	Peking University
Proximal Gastrectomy Anterior Anastomosis With Pyloroplasty Versus Esophagogastric Anastomosis for Gastric Cancer	NCT05514769	Proximal Gastri... Gastric Cancer Gastroesophagea...	Proximal Gastre...	18 Years - 85 Years	Nanchong Central Hospital
Proximal Gastrectomy Anterior Anastomosis With Pyloroplasty Versus Esophagogastric Anastomosis for Gastric Cancer	NCT05514769	Proximal Gastri... Gastric Cancer Gastroesophagea...	Proximal Gastre...	18 Years - 85 Years	Nanchong Central Hospital

Spots Global Cancer Trial Database for proximal gastric adenocarcinoma