- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04919577
Predictive Factors for Roux Stasis Syndrome (PFRSS)
Predictive Factors for Roux Stasis Syndrome After Distal Gastrectomy With Roux-en-Y Reconstruction in Gastric Cancer Patients: A Retrospective Comparative Cohort
Study Overview
Detailed Description
Patient Selection Ethical approval for this study was obtained from the medical ethics research committee of Peking University Third Hospital (IRB00006761-2019173).
Consecutive patients who were pathologically diagnosed with gastric cancer and underwent distal gastrectomy with R-Y reconstruction between March 2014 and March 2021 at Peking University Third Hospital were retrospectively selected (the detailed screening process was shown in Figure 1).
The exclusion criteria for this study were: (1) patients with distant metastasis, (2) patients with palliative surgery, (3) death occurred within 14 days after operation, (4) patients with primary malignant disease in other organs besides stomach.
Surgical Procedure RY reconstruction was performed after standard distal gastrectomy and D2 lymph node dissection. There are several key steps involved in the RY reconstruction process. Firstly, the jejunum was dissected at 20.2cm (average value) distal to Treitz's ligament. Secondly, a side-to-side antecolic gastrojejunostomy was created using a linear stapler between the gastric stump and the distal segment of jejunum. Finally, an end-to-side or side-to-side jejunostomy was performed in output limb at about 37.2cm (average value) distal to the gastrojejunostomy (Figure 2). A cholecystectomy was performed if the patient had gallbladder-related disease.
Data collection We divided these patients into two group depending on whether RSS occurred and retrospectively analyzed the following items: gender, age, body mass index (BMI), smoking, diabetes, high carcinoembryonic antigen (CEA), hypoproteinemia, hyperlipidemia, operation approach, operation time, cholecystectomy, length of input and output loops, intestinal anastomosis approach, pathological T (pT) stage, lymph node metastasis, pathological stage, lymphovascular invasion, nerve invasion and postoperative hospital stay. According to the standard classification of BMI in China11, we divided patients into three groups, including underweight group (BMI < 18.5 kg/m2), obesity group (BMI ≥ 28.0 kg/m2) and normal group (18.5 kg/m2 ≥ BMI < 28.0 kg/m2). The cancer stage was defined according to the 8th cancer Edition Cancer Staging System presented by American Joint Committee on Cancer.
Identification of RSS We defined RSS as (1) the presence of symptoms such as nausea, vomiting, or abdominal fullness, (2) refasting after liquid or semi-liquid diets, (3) imaging methods (X-ray, CT, upper gastroenterography) confirmed without mechanical obstruction. All three conditions must be met at the same time and should occur within 30 days after operation.
Two gastroenterologists screened each patient one by one according to the RSS definition. The third gastroenterologist discussed the inconsistent patients and jointly confirmed whether the patient had RSS.
Statistical Analysis Statistical analysis was performed using the SPSS Statistics version 26.0 software program (IBM, USA). Qualitative data were compared using the chi-square test or Fisher's exact test. Quantitative data were tested by nonparametric test with Mann-Whitney U test. We choose the variables with P < 0.1 in univariate analysis and the variables that may be related to RSS clinically to be included in multivariate analysis, using Binary logistic regression analysis (Forward Conditional). Box-Tidwell method was used to verify that the continuous independent variable and the dependent variable logit transform value to be linear relationship (p > 0.05). Linear regression was used to verify that there was no multicollinearity between each independent variable (Tolerance > 0.1, VIF < 10). Based on the logistic regression results, a nomogram for predicting RSS occurrence after radical gastrectomy for distal gastrectomy with RY anastomosis was established, and performance was quantified to determine discrimination and calibration. The model was internally validated using the 1,000 bootstrapping method to obtain relatively unbiased estimates. Nomogram was built using the "rms" package in R version 3.5.2.All tests were bilateral, and P < 0.05 was considered statistically significant.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
Beijing
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Beijing, Beijing, China, 100191
- General Surgery Department, Peking University Third Hospital
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- ADULT
- OLDER_ADULT
- CHILD
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- pathologically diagnosed with gastric cancer
- underwent distal gastrectomy with R-Y reconstruction
- the date of admission is between March 2014 and March 2021
- the admission place is Peking University Third Hospital.
Exclusion Criteria:
- patients with distant metastasis
- patients with palliative surgery
- death occurred within 14 days after operation
- patients with primary malignant disease in other organs besides stomach.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
RSS- Group
Patients without RSS after distal gastrectomy.
|
We defined RSS as (1) the presence of symptoms such as nausea, vomiting, or abdominal fullness, (2) refasting after liquid or semi-liquid diets, (3) imaging methods (X-ray, CT, upper gastroenterography) confirmed without mechanical obstruction.
All three conditions must be met at the same time and should occur within 30 days after operation.
Other Names:
|
RSS+ Group
Patients with RSS after distal gastrectomy.
|
We defined RSS as (1) the presence of symptoms such as nausea, vomiting, or abdominal fullness, (2) refasting after liquid or semi-liquid diets, (3) imaging methods (X-ray, CT, upper gastroenterography) confirmed without mechanical obstruction.
All three conditions must be met at the same time and should occur within 30 days after operation.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Roux stasis syndrome
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or No.
We defined RSS as (1) the presence of symptoms such as nausea, vomiting, or abdominal fullness, (2) refasting after liquid or semi-liquid diets, (3) imaging methods (X-ray, CT, upper gastroenterography) confirmed without mechanical obstruction.
If all three conditions meet at the same time and occur within 30 days after operation, we choose Yes, otherwise, we choose No.
|
2014.03.01 to 2021.03.01
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Age
Time Frame: 2014.03.01 to 2021.03.01
|
unit: years.
Checking the admission record.
|
2014.03.01 to 2021.03.01
|
body mass index (BMI)
Time Frame: 2014.03.01 to 2021.03.01
|
unit: kg/m^2.
Checking the admission record, get the information of weight in kilograms and height in meters, weight/height^2 get the BMI.
|
2014.03.01 to 2021.03.01
|
smoking, diabetes
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or No. Checking the admission record for a history of smoking and diabetes.
|
2014.03.01 to 2021.03.01
|
operation approach
Time Frame: 2014.03.01 to 2021.03.01
|
Open or Laparoscopic.
Checking the surgery record.
|
2014.03.01 to 2021.03.01
|
operation time
Time Frame: 2014.03.01 to 2021.03.01
|
unit: min.
Checking the anesthesia record.
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2014.03.01 to 2021.03.01
|
cholecystectomy
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or No. Checking the surgery record to determine if cholecystectomy is complicating.
|
2014.03.01 to 2021.03.01
|
high carcinoembryonic antigen (CEA)
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or No. Checking preoperative laboratory values, if CEA < 5.0 ng/ml choose No, if CEA ≥ 5.0 ng/ml, choose Yes.
|
2014.03.01 to 2021.03.01
|
hypoproteinemia
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or No. Checking preoperative laboratory values, if albumin < 30.0 g/l choose Yes, if albumin ≥ 30.0 g/l , choose No.
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2014.03.01 to 2021.03.01
|
length of input and output loops
Time Frame: 2014.03.01 to 2021.03.01
|
unit: cm.
Checking the surgery record.
|
2014.03.01 to 2021.03.01
|
intestinal anastomosis approach
Time Frame: 2014.03.01 to 2021.03.01
|
End-to-side or Side-to-side.
Checking the surgery record.
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2014.03.01 to 2021.03.01
|
pathological T (pT) stage
Time Frame: 2014.03.01 to 2021.03.01
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I or II or III.
Checking the postoperative pathological report.
The cancer stage was defined according to the 8th cancer Edition Cancer Staging System presented by American Joint Committee on Cancer.
|
2014.03.01 to 2021.03.01
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lymph node metastasis, lymphovascular invasion, nerve invasion.
Time Frame: 2014.03.01 to 2021.03.01
|
Yes or NO.
Checking the postoperative pathological report.
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2014.03.01 to 2021.03.01
|
postoperative hospital stay
Time Frame: 2014.03.01 to 2021.03.01
|
unit: days.
Checking the surgery and discharge record.
The length of postoperative hospital stay is obtained by subtracting the date of discharge from the date of surgery.
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2014.03.01 to 2021.03.01
|
Gender
Time Frame: 2014.03.01 to 2021.03.01
|
Male or Female.
Checking the admission record.
|
2014.03.01 to 2021.03.01
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Wei Fu, MD, General Surgery Department, Peking University Third Hospital
- Principal Investigator: Xin Zhou, MD, eneral Surgery Department, Peking University Third Hospital
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PekingUTH M2019173
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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