Impact of Roux-En-Y Pouch Reconstruction Compared With Conventional Roux-En-Y Reconstruction on Health-Related Quality of Life in Patients Undergoing Total Gastrectomy for Adenocarcinoma

NCT01491698 | Completed Phase 3

• 1 other identifier: 11-070
• Study Type: interventional
• Target: 12
• Locations: 1 country
• Sites: 1

Brief Summary

This study is being done to learn more about how different surgery procedures bring back the eating pathway after removing the stomach in patients with stomach cancer. If the surgeon has decided that some, or all, of the patient's stomach must be removed the surgeon must create a new way to allow food to travel from the mouth to the intestines. Some patients develop problems because they are missing their stomach, such as lack of hunger, bloating, cramping, and heartburn. The surgeons at Memorial Sloan-Kettering Cancer Center are conducting a study to determine if a change in surgery can help reduce these symptoms. The most common method of creating a way for food is called a "Roux-en-Y", in which one part of the intestine is connected with the end of the esophagus (the swallowing tube) in the abdomen, and another connection is made between the intestines lower down. The change in surgery involves creating a pouch from a part of the intestines to replace the stomach. This study will compare the effects, good and/or bad, of gastric pouch reconstruction with the usual reconstruction to see if the pouch makes you feel better overall. This type of surgery has been used by some surgeons for many years and is known to be safe, but it is not known if it reduces symptoms or improves nutrition compared with the usual surgery.

Conditions

Gastric Cancer

Keywords

stomach; surgery; Total Gastrectomy; Roux-En-Y Pouch Reconstruction; Conventional Roux-En-Y Reconstruction; Quality of Life; 11-170

Outcome Measures

Primary Outcomes (1)

• feasibility

  of recruiting patients with gastric adenocarcinoma to this randomized controlled trial (RCT). We will assess this based on the number of patients who are randomized during the pilot study.

  2 years

Secondary Outcomes (1)

• change in HRQOL ( Health-Related Quality of Life)

  2 years

Study Arms (2)

pts undergoing Roux-en-Y pouch reconstruction (RYP)

EXPERIMENTAL

This is a pilot randomized controlled trial comparing changes in health-related quality of life (HRQOL) in patients undergoing Roux-en-Y pouch reconstruction (RYP) with patients undergoing conventional Roux-en-Y reconstruction (RYC) following total gastrectomy for adenocarcinoma.

Procedure: Roux-en-Y pouch reconstruction (RYP)

pts undergoing conventional Roux-en-Y reconstruction (RYC)

ACTIVE COMPARATOR

This is a pilot randomized controlled trial comparing change in health-related quality of life (HRQOL) in patients undergoing Roux-en-Y pouch reconstruction (RYP) with patients undergoing conventional Roux-en-Y reconstruction (RYC) following total gastrectomy for adenocarcinoma.

Procedure: conventional Roux-en-Y reconstruction (RYC)

Interventions

Roux-en-Y pouch reconstruction (RYP) PROCEDURE

Patients will be consented to the study and complete pre-surgical questionnaires. Final randomization will occur once the surgeon in the operating room has confirmed eligibility intraoperatively. The envelope will be opened, and the patient randomized to either receive RYP or RYC. There are no restrictions on how surgeons may create the RYC or RYP reconstruction, except that the pouch must be a minimum of 15 cm in length (from esophago-jejunal anastomosis to end of jejuno-jejunal anastomosis).

Also known as: Patients will be seen in follow-up at intervals congruent with routine post-operative, care: post-operative (approximately 1 month), 3 months, 6 months, 12 months,, and 24 months following surgery (+- one month at each time interval to allow, flexibility in scheduling). At each of these visits patients will complete the, HRQOL questionnaires, which require approximately 30 minutes total.

pts undergoing Roux-en-Y pouch reconstruction (RYP)

conventional Roux-en-Y reconstruction (RYC) PROCEDURE

Patients will be consented to the study and complete pre-surgical questionnaires. Final randomization will occur once the surgeon in the operating room has confirmed eligibility intraoperatively. The envelope will be opened, and the patient randomized to either receive RYP or RYC. There are no restrictions on how surgeons may create the RYC or RYP reconstruction, except that the pouch must be a minimum of 15 cm in length (from esophago-jejunal anastomosis to end of jejuno-jejunal anastomosis).

Also known as: Patients will be seen in follow-up at intervals congruent with routine post-operative care:, post-operative (approximately 1 month), 3 months, 6 months, 12 months, and, 24 months following surgery (+- one month at each time interval to allow flexibility in scheduling). At each of these visits patients will complete the, HRQOL questionnaires, which require approximately 30 minutes total.

pts undergoing conventional Roux-en-Y reconstruction (RYC)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient 18 years of age or older
• Pathologically confirmed gastric adenocarcinoma at MSKCC (biopsy may be performed at other institutions but slides must be confirmed at MSKCC, as is routine care at our institution)
• No evidence of metastases(a)
• Total gastrectomy performed(b)
• Pouch reconstruction is technically feasible(c)
• Patients will be registered and consent obtained, if the surgeon believes there is no evidence of metastases. If metastatic disease is identified at the time of operation, the patient will not be randomized.
• Patients will be conditionally enrolled, and consent obtained, if the surgeon believes the patient may need a total gastrectomy at the time of operation. If a total gastrectomy is not performed, the patient will not be randomized.
• Patients will be excluded if, at the time of surgery, the surgeon feels that creation of a pouch is not technically feasible. This may be due to prior abdominal surgery, anatomic variants, or anything else at the surgeon's discretion.

You may not qualify if:

• Not expected to be able to provide follow-up over 2 years (due to geographic or other limitations)
• Not able to complete HRQOL instruments on their own (non-English speaking or physical status)

Sponsors & Collaborators

• Memorial Sloan Kettering Cancer Center: lead
• Weill Medical College of Cornell University: collaborator
• McMaster University: collaborator

Study Sites (1)

Memorial Sloan Kettering Cancer Center

New York, New York, 10065, United States

Location

Related Links

• Memorial Sloan-Kettering Cancer Center

MeSH Terms

Conditions

Stomach Neoplasms

Interventions

Pliability; Postoperative Period

Condition Hierarchy (Ancestors)

Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Stomach Diseases

Intervention Hierarchy (Ancestors)

Mechanical Phenomena; Physical Phenomena; Perioperative Period; Surgical Procedures, Operative; Patient Care; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Daniel Coit, MD

  Memorial Sloan Kettering Cancer Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 9, 2011
• First Posted: December 14, 2011
• Study Start: December 1, 2011
• Primary Completion: August 1, 2013
• Study Completion: August 1, 2013
• Last Updated: August 15, 2013

Record last verified: 2013-08

Locations

US (1)