Reconstruction With a Lawrence-Hunt Jejunal Pouch for Upfront Total Gastrectomy - Study Protocol of a Prospective, Single-arm, Phase II Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 26
- Locations
- 3
- Primary Endpoint
- Dumping syndrome reduction rate
Study Overview
Brief Summary
The aim of the study is to establish the efficacy of jejunal pouch reconstruction in reducing dumping syndrome in patients undergoing total gastrectomy, ultimately enhancing postoperative quality of life and nutritional status.
Detailed Description
Total gastrectomy (TG) with Roux-en-Y (RY) esophageal-jejunal anastomosis is performed for various gastric malignancies or as a prophylactic strategy in patients with hereditary diffuse gastric cancer syndrome harboring CDH1 mutation at risk of developing gastric cancer. The surgical procedure is, however, complicated in the post-operative months by weight loss and nutritional deficiency in most patients, requiring frequent follow-up, and by functional issues such as reflux and dumping syndrome in about 30% of cases, which significantly impact the patient's quality of life. To prevent the poorer outcomes reported by patients undergoing total gastrectomy, one strategy could be a modification of the reconstruction method using a jejunal pouch reconstruction (JP) that may mitigate symptoms by slowing gastric emptying and enhancing nutrient absorption. JP has so far proven several benefits in improving postoperative outcomes (reflux and dumping syndrome), nutritional outcomes, and QoL up to 2 years after surgery. The technique has been mostly studied in the Eastern countries (Japan and South Korea) and, since 2021, has been recommended by the French Association of Surgery as the technique of choice for reconstruction after total gastrectomy. However, in most European centers, this technique has not yet been introduced as a routine procedure due to a relative lack of data on the clinical benefit and risk profile in the Western population.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 75 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Adults aged 18-75 years.
- •Histologically confirmed gastric tumor (including adenocarcinoma, gastrointestinal stromal tumor - GIST- or neuroendocrine tumor) or patients with CDH1 mutation, scheduled for TG with a maximal esophageal resection of < 6 cm.
- •Informed consent capability.
Exclusion Criteria
- •Prior abdominal surgeries affecting the jejunum.
- •Severe comorbidities or non-appropriate organ function: uncontrolled diabetes with HbA1C > 7.5, significant heart disease: New York Heart Association (NYHA) functional classification Class III or IV, chronic obstructive pulmonary disease (COPD) requiring oxygen supplementation or continuous positive airway pressure (CPAP), chronic corticosteroid therapy (daily for more than 6 months), neutrophil count < 2000/mm3, hemoglobin < 8.0 g/dL, platelet count < 100,000/mm3, serum total bilirubin > 1.5 mg/dL, serum aspartate aminotransferase (AST) >100 IU/L, serum alanine aminotransferase (ALT) >100 IU/L, and creatinine clearance (CCr) ≥ 50 mL/min), ECOG performance status >
- •Pregnancy or breastfeeding.
Arms & Interventions
Open or laparoscopic TG followed by JP reconstruction.
All participants will undergo open or laparoscopic Total Gastrectomy (TG) followed by Jejunal Pouch (JP) reconstruction.
Intervention: Jejunal Pouch reconstruction. (Procedure)
Outcomes
Primary Outcomes
Dumping syndrome reduction rate
Time Frame: 12 months after surgery
Evaluate the reduction in the incidence of dumping syndrome after TG with JP reconstruction with the Sigstad questionnaire.
Secondary Outcomes
- Postoperative complications(12 months after surgery)
- Nutritional status(3, 6 & 12 months after surgery)
- Gastrointestinal Quality of Life Index (GIQLI)(3, 6 & 12 months after surgery)
- Nutritional status - weight(3, 6 & 12 months after surgery)
- Nutritional status - height(3, 6 & 12 months after surgery)
- Nutritional status - Body Mass Index (BMI)(3, 6 & 12 months after surgery)
- Dumping syndrome severity(The DSS was administered at 3, 6, and 12 months after surgery.)
- Nutritional status - weight(3, 6 & 12 months after surgery)
- Nutritional status - height(3, 6 & 12 months after surgery)
- Nutritional status - Body Mass Index (BMI)(3, 6 & 12 months after surgery)
- EORTC QLQ-C30(Assessments were performed at 3, 6, and 12 months after surgery)
- Nutritional status(3, 6 & 12 months after surgery)
- Gastrointestinal Quality of Life Index (GIQLI)(3, 6 & 12 months after surgery)
- Postoperative complications(12 months after surgery)