Impact of Gastric Tube Reconstruction Widths on Quality of Life for Esophagogastric Cancers

The incidence of cancer of the esophagogastric junction has rapidly risen in recent three decades, and surgery still remains the optimum therapy. For Siewert's type II and III cancer, esophagojejunostomy after total gastrectomy and Roux-en-Y gastrojejunostomy after subtotal gastrectomy are regarded as the two main surgical approaches. Esophagojejunostomy after total gastrectomy brings high survival rate and low local recurrence rate which may also induces pulmonary infection or regurgitation. Roux-en-Y gastrojejunostomy after subtotal gastrectomy needs reconstruction of the gastric tube and the width of reconstruction tube was a key factor to predicate prognosis. However, no evidence supplies a comprehensive standard on the width of reconstruction tube which often ranges from 3 cm to 6 cm. Both narrow and wide reconstruction tubes have their own advantages and disadvantages. So the prospective trail recruits patients into three groups: total gastrostomy group (TG group), wide gastric tube group (WG group) and narrow gastric tube group (NG group). And the investigators compare the quality of life using integrated questionnaire of QLQ-STO22 and QLQ-C30 and related symptom relief as main endpoints.

Sex

All

Minimum age

18 Years

Maximum age

80 Years

Inclusion Criteria:

1. pathologically confirmed esophagogastric cancers
2. age between 18 to 80 years
3. no evidence of metastasis of adjacent organs
4. organs function well to tolerate surgery
5. no special treatment before surgery
6. informed consent was written

Exclusion Criteria:

1. with other site tumor,simultaneously
2. locally recurrent gastric or esophageal cancer
3. had a history of malignant tumor within 5 years(except the skin cancer)
4. pregnant or lactating women
5. there was contraindication for operation
6. discovery of metastasis in the operation
7. with mental disorder

• BACKGROUNDVial M, Grande L, Pera M. Epidemiology of adenocarcinoma of the esophagus, gastric cardia, and upper gastric third. Recent Results Cancer Res. 2010;182:1-17. doi: 10.1007/978-3-540-70579-6_1. PMID 20676867
• BACKGROUNDHasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer. 2010 Jun;13(2):63-73. doi: 10.1007/s10120-010-0555-2. Epub 2010 Jul 3. PMID 20602191
• BACKGROUNDAllum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol. 2009 Oct 20;27(30):5062-7. doi: 10.1200/JCO.2009.22.2083. Epub 2009 Sep 21. PMID 19770374
• BACKGROUNDMariette C, Piessen G, Briez N, Gronnier C, Triboulet JP. Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol. 2011 Mar;12(3):296-305. doi: 10.1016/S1470-2045(10)70125-X. Epub 2010 Nov 23. PMID 21109491
• BACKGROUNDJohansson J, Djerf P, Oberg S, Zilling T, von Holstein CS, Johnsson F, Walther B. Two different surgical approaches in the treatment of adenocarcinoma at the gastroesophageal junction. World J Surg. 2008 Jun;32(6):1013-20. doi: 10.1007/s00268-008-9470-7. PMID 18299921
• BACKGROUNDIelpo B, Pernaute AS, Elia S, Buonomo OC, Valladares LD, Aguirre EP, Petrella G, Garcia AT. Impact of number and site of lymph node invasion on survival of adenocarcinoma of esophagogastric junction. Interact Cardiovasc Thorac Surg. 2010 May;10(5):704-8. doi: 10.1510/icvts.2009.222778. Epub 2010 Feb 13. PMID 20154347
• BACKGROUNDDe Giacomo T, Francioni F, Venuta F, Trentino P, Moretti M, Rendina EA, Coloni GF. Complete mechanical cervical anastomosis using a narrow gastric tube after esophagectomy for cancer. Eur J Cardiothorac Surg. 2004 Nov;26(5):881-4. doi: 10.1016/j.ejcts.2004.07.024.