Recruiting nowNot applicableInterventional
What this study is about
This is a prospective, multi-center, randomized controlled trial to compare Billroth II reconstruction versus conventional Roux-en-Y reconstruction versus long limb Roux-en-Y reconstruction for glycemic control in patients with concurrent type 2 diabetes and gastric cancer.
A promising-looking record is not the same as confirmed eligibility. The study team must review the full criteria and current recruitment status.
Basic eligibility
Age20 Years to 69 Years
SexAll
Healthy volunteersNot accepted
ConditionGastric Cancer, Diabetes Mellitus, Type 2
Full registry criteria
Inclusion Criteria: * Distal gastric adenocarcinoma diagnosed pathologically under preoperative endoscopic biopsy, and clinical stage I-II * Body mass index ≥ 23 kg/m2 * Type 2 diabetes and HbA1c ≥ 6.5% Exclusion Criteria: * Insulin usage for glycemic control at the time of screening evaluation * Prior gastrointestinal surgery including splenectomy, hepatobiliary and pancreatic surgery (except hemorrhoidectomy, herniorrhaphy, and appendectomy) * Abdominal, thoracic, pelvic and/or obstetric-gynecologic surgery within 3 months * Cardiovascular conditions including significant known CAD, uncompensated congestive heart failure, history of stroke, or uncontrolled hypertension. Subjects with CAD that have been successfully treated with CABG or PCI, and have no evidence of active ischemia are eligible * Kidney disease including renovascular hypertension, renal artery stenosis, or end-stage renal disease * Chronic liver disease including liver cirrhosis, alpha-1 antitrypsin deficiency * Gastrointestinal disorders including inflammatory bowel disease (Crohn's disease or ulcerative colitis) or any malabsorptive disorders * Psychiatric disorders including dementia, active psychosis, history of suicide attempts, alcohol or drug abuse within 12 months * Severe pulmonary disease defined as FEV1 \<50% of predicted value * Anemia defined as hemoglobin less than 8 in females and 10 in males * Malignancy within 5 years (except squamous cell and basal cell cancer of the skin). Subjects diagnosed with early or stage I cancer than have been successfully treated are eligible per investigator discretion * Frail elderly (Rockwood Clinical Frailty Scale ≥5) * Any condition or major illness that, in the investigator's judgement, places the subject at undue risk by participating in the study * Unable to understand the risks, realistic benefits and compliance requirements of each program * Use of investigational therapy or participation in any other clinical trial within 3 months * Geographic inaccessibility * Pregnancy
Treatments and study arms
Long limb Roux-en-Y reconstruction after subtotal gastrectomy
Procedure
The jejunum will be divided approximately 150 cm distal to the ligament of Treitz (Length of biliopancreatic limb). The gastrojejunostomy will be performed by end-to-end anastomosis and an anastomosis of the proximal end of the jejunum to the distal jejunum will be created approximately 50 cm distal from the gastrojejunal anastomosis (Length of Roux-en-Y limb).
Conventional Roux-en-Y reconstruction after subtotal gastrectomy
Procedure
The jejunum will be divided approximately 20 cm distal to the ligament of Treitz (Length of biliopancreatic limb). The gastrojejunostomy will be performed by end-to-end anastomosis and an anastomosis of the proximal end of the jejunum to the distal jejunum will be created approximately 30-45 cm distal from the gastrojejunal anastomosis (Length of Roux-en-Y limb).
Billroth II reconstruction after subtotal gastrectomy
Procedure
The duodenum will be transected approximately 2 cm distal to the pylorus and anastomosis will be performed between the gastric remnant and a loop of jejunum chosen approximately 20 cm distal to the ligament of Treitz (Length of afferent loop)
