Comparison of Subtotal Stomach and Narrow Gastric Tube After Esophagectomy

University Medical Center Ho Chi Minh City (UMC)

Status: Not yet enrolling

Conditions: Esophageal Cancer

Treatments: Procedure: Narrow gastric tube

Study type: Interventional

Funder types: Other

Identifiers

NCT05342805

16/GCN-HDDD 2022

Details and patient eligibility

About

Currently, both the subtotal stomach and narrow gastric tube approaches are widely used for esophagogastric anastomosis after esophagectomy. Some stud- ies have concluded that the subtotal gastric conduit is superior to the wide gastric-tube approach, as it provides better protection of the submucosal vessels and can slightly increase gastric capacity.

Furthermore, blood perfusion significantly decreases after tubular gastric surgery.

Full description

Stomach is the most common esophageal subtitute after a esophagectomy procedure, because it has a abundant blood supply and the need for only one anastomosis. However, cervical esophago-gastro anastomosis still has a high risk of complications, especially anastomosis leakage (11.9 - 25 % ).

There are three types of gastric subtitute: whole stomach, subtotal stomach and narrow gastric tube. While whole stomach and subtotal stomach has an advantage in the submucosal vascular network, a narrow tube is excellent elasticity and the ease with which it can be pulled up into the neck without tension, that could affect leakage rate.

On the other hand, after esophagectomy, nutrition status and quality of life (QoL) had decreased due to effect of adjuvant therapy, lower quantity of food intake, gastro-esophageal reflux and other postoperative syndromes. Several studies had shown the affect of the width of gastric tube to the postoperative nutrition and QoL, however, the results were not homogenous. This study aims to compared two types of gastric subtitute after esophagectomy: subtotal stomach and narrow gastric tube

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Pathologic finding by esophageal endoscopy: confirmed esophageal cancer.
• Indication for esophagectomy
• Age: 18 - 80 year old
• Tumor located at the middle or lower third of the esophagus
• ASA score: ≤ 3
• Informed consent patients (explanation about our clinical trials is provided to the patients or patrons, if patient is not available)

Exclusion criteria

• Concurrent cancer or patient who was treated due to other cancer before the patient was diagnosed esophageal cancer
• Pregnant patient
• Using colon or intesinal conduit

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

Subtotal stomach

Experimental group

Description:

The vessels at the anastomosis of right and left gastric arteries were separated, then the proximal haft of lesser curvature and cardia was resected using linear staplers.

Treatment:

Procedure: Narrow gastric tube

Narrow gastric tube

Active Comparator group

Description:

At the lesser curvature, the resection began at the point that was 5-cm from the pyloric, toward to the greater curvature, then the stomach was divided along 3 cm from the greater curvature using linear stapler.

Treatment:

Procedure: Narrow gastric tube