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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT06192212
Other study ID # WeiGuo
Secondary ID
Status Active, not recruiting
Phase
First received
Last updated
Start date December 13, 2023
Est. completion date June 1, 2024

Study information

Verified date January 2024
Source Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

As there is no consensus to date on the optimal postoperative nutritional support route for patients undergoing minimally invasive esophagectomy, the purpose of this study is to assess whether there is a potential advantage to receiving jejunostomy feedings for postoperative patients undergoing McKeown MIE as compared to the conventional nasoenteric tube feeding method.


Description:

Esophageal cancer ranks ninth globally in terms of cancer incidence and sixth in terms of cancer deaths. In addition to the tumor itself and the surgical strike, nutrition and complications are two key factors limiting the rapid recovery of esophagectomy patients. A large number of studies have shown that rational nutritional support will help to improve the nutritional status of postoperative patients and reduce the risk of complications, and compared with parenteral nutrition, enteral nutrition has the advantages of lower complication rate, more economical and safer. Therefore, enteral nutrition is often recommended for esophageal cancer patients in the early postoperative period. However, the commonly used clinical enteral nutrition includes transoral, nasoenteric tube (NT), gastrostomy and jejunostomy tube (JT) feeding. The optimal method of enteral nutrition after esophageal cancer surgery has been hotly debated in various published articles, but contradictions still exist. There have been numerous studies in recent years on the routine placement of jejunostomy tubes after esophageal cancer surgery, but none of them has yet reached an unanimously accepted conclusion. Theoretically, a JT reduces the risk of detachment compared with an NT because the catheter is sutured to the abdominal wall; at the same time, a JT is placed deeper than an NT and farther away from the pyloric inlet, thus reducing the incidence of reflux. Most importantly, jejunostomy is considered to be comfortable and effective for long-term nutritional support, and patients can achieve long-term tube feeding at home through the JT, which can satisfy early discharge in case of insufficient oral intake and prevent readmission due to insufficient transoral intake. Some studies have also confirmed these views, claiming that jejunostomy does not increase the incidence of total complications but improves QOL scores and short-term nutritional indices. It also eliminates the foreign body sensation of nasal mucosal nutritional tubes, and these patients showed acceptable tolerance to catheter insertion. Some researchers have also shown that jejunostomy does not affect the long-term oncological outcomes of patients undergoing esophageal cancer surgery, while increasing the incidence of perioperative complications, with data showing an overall complication rate of 13-38% after jejunostomy, and 0-3% of patients experiencing serious complications that require management, and therefore is not routinely recommended. In summary, the final conclusion of the current clinical studies on whether to adopt jejunostomy after esophageal cancer resection is still controversial. Meanwhile, to the best of our knowledge, no study has yet examined the circumstances under which the option of performing a jejunostomy may be beneficial to patients. Therefore, in this study, on the basis of analyzing the relationship between the routine placement of jejunostomy tubes and tumor outcomes, and investigating whether jejunostomy brings benefits to patients after esophageal cancer surgery, we propose to conduct subgroup analyses of OS to clarify whether it may bring clear benefits to patients under certain circumstances, so as to guide clinicians to choose to perform this procedure in an appropriate manner.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 577
Est. completion date June 1, 2024
Est. primary completion date December 25, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years to 80 Years
Eligibility Inclusion Criteria: - 1. Patients with a clear pathologic diagnosis of esophageal squamous cell carcinoma; 2. Received minimally invasive McKeown procedure; 3. Patients with R0 resection (R0: radical resection). Exclusion Criteria: - 1. Biopsy pathologic diagnosis of other types of esophageal cancer, e.g., adenocarcinoma; 2. Simultaneous combination of other primary cancers or history of other cancers; 3. Received minimally invasive Ivor-Lewis procedure or Sweet procedure; 4. Patients with R1 or R2 resection (R1 resection: microscopic tumor residue; R2: naked eye tumor residue); 5. Preoperative distant metastases; 6. Preoperative serious comorbidities in other systems; 7. Incomplete medical record data.

Study Design


Related Conditions & MeSH terms


Locations

Country Name City State
China Army Medical Center of the People's Liberation Army Chongqing Chongqing

Sponsors (1)

Lead Sponsor Collaborator
Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

Country where clinical trial is conducted

China, 

Outcome

Type Measure Description Time frame Safety issue
Primary postoperative adverse events including pneumonia, adult respiratory distress syndrome (ARDS), anastomotic leak (AL), vocal cord paralysis, chylothorax, pneumothorax, pleural effusion, cardiovascular complications Within 90 days after surgery
Primary perioperative 90-day mortality. Within 90 days
Secondary Albumin loss rate ((Preoperative albumin-POD7~10 albumin))/(Preoperative albumin) *100% 7-10 days after surgery
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