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.
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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
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
University Medical Center Ho Chi Minh City
Ho Chi Minh City, Vietnam
Early complications (30-day complications): rate of anastomotic leakage
Comparison of the rate of anastomotic leakage. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early complications (30-day complications): rate of anastomotic stricture
Comparison of the rate of anastomotic stricture. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early complications (30-day complications): rate of bleeding
Comparison of the rate of bleeding. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early complications (30-day complications): rate of pneumonia
Comparison of the rate of pneumonia. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early complications (30-day complications): rate of mortality.
Comparison of the rate of anastomotic leakage. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early complications (30-day complications): rate of reoperation.
Comparison of the rate of reoperation. All complications will be classified according to the Clavien-Dindo classification.
Time frame: 30 days after surgery
Early outcomes (30-day post operative): length of hospital stay.
Comparison of the length of hospital stay.
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Time frame: 30 days after surgery
Early outcomes (30-day post operative): day of oral intake.
Comparison of the day of oral intake.
Time frame: 30 days after surgery
Postoperative nutritional status: body weight
Comparison of body weight at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after surgery
Postoperative nutritional status: serum total protein
Comparison of serum total protein at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after surgery
Postoperative nutritional status: albumin level
Comparison of albumin level at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after surgery
Postoperative nutritional status: hemoglobin
Comparison of hemoglobin at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after surgery
Reflux esophagitis
Reflux esophagitis will be evaluated using the Los Angeles classification at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after surgery
Residue Gastritis Bile
RGB (Residue Gastritis Bile) classification will be used to evaluate status of remnant stomach 6 to 12 months after surgery
Time frame: 6, 12 months and 1 year after
Patients' health-related quality of life
Patients' health-related quality of life will be evaluated using GSRS (Gastrointestinal Symptom Rating Scale) score at 6, 12 months and every year after surgery
Time frame: 6, 12 months and 1 year after
Late complications: anastomotic stricture
Comparison of the rate anastomotic stricture complications during the follow-up period
Time frame: 6, 12 months and 1 year after
Late complications: anastomotic ulcer
Comparison of anastomotic ulcer during the follow-up period
Time frame: 6, 12 months and 1 year after
Others late complications
Comparison of other late complications during the follow-up period
Time frame: 6, 12 months and 1 year after
Oncological outcomes: overall survival rate
Comparison of overall survival rate during the follow-up period
Time frame: 6, 12 months and 1 year after
Oncological outcomes: rate of death due to the cancer
Comparison of rate of death due to the cancer, and death from all causes during the follow-up period
Time frame: 6, 12 months and 1 year after
Oncological outcomes: recurrence, metastasis
Comparison of recurrence, metastasis during the follow-up period
Time frame: 6, 12 months and 1 year after