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Advanced Gastric CarcinomaNCT05545293

Prospective Study on Double-Stapling End-to-End Gastroduodenostomy Billroth-I Anastomosis in Laparoscopy-Assisted Surgery for Locally Advanced Distal Gastric Cancers

An observational study of Advanced Gastric Carcinoma, run by West China Hospital at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to explore the clinical application value of Double-Stapling End-to-End Gastroduodenostomy Billroth-I Anastomosis in Laparoscopy-Assisted Surgery for Locally Advanced Distal Gastric Cancers. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Advanced Gastric Carcinoma
How many people
100 participants
Where
1 siteChina
Study dates
14 Sep 2017to 6 Dec 2025
How long will I take part?
30 Days
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: All eligible patients enrolled in this study would undergo double-stapling end-to-end gastroduodenostomy Billroth-I anastomosis in laparoscopy-assisted surgery

Who may be able to join

  • Age from 18 to years (including 18 and 85years old)
  • Pathological diagnosis of primary focus is gastric adenocarcinoma made by endoscopic biopsy (papillary, tubular, mucinous, signet ring cell, poorly differentiated)
  • cT1-4a, N+/-, M0 at preoperative evaluation
  • No peritoneal metastasis or other distant metastases of gastric carcinoma (affirmed by laparoscopic surgery and related imaging examinations)
  • Expected curative resection through laparoscopic distal gastrectomy with D2 lymphadenectomy (include multiple primary lower gastric adenocarcinoma)
  • Performance status of 0 or 1 on Eastern Cooperative Oncology Group scale (ECOG)
Show all 10Show fewer
  • Preoperative American Society of Anesthesiology score (ASA) classⅠ, Ⅱ or Ⅲ
  • Major organs are functioning normally:
  • blood routine test (No blood transfusions in the last 14 days): HB≥90g/L, ANC≥1.5×109/L, PLT≥80×109/L blood biochemical examination: BIL<1.5× upper limit of normal (ULN), ALT and AST<2.5×ULN, Crea≤1×ULN.
  • The subject is willing to participate in this clinical trail

Who cannot join

  • History of previous upper abdominal surgery (include ESD/EMR, except laparoscopic cholecystectomy)
  • History of acute pancreatitis
  • Regional fusion of enlarged lymph nodes by preoperative imaging (maximum diameter >3cm)
  • History of other malignant disease within past five years
  • History of unstable angina, myocardial infarction, cerebral infraction, or cerebral hemorrhage within past six months
  • History of continuous systematic corticosteroids therapy within past one month
Show all 17Show fewer
  • Requirement of simultaneous surgery for other disease
  • Emergency surgery due to complication (bleeding, or perforation) caused by gastric cancer
  • FEV1<50% of predicted values by pulmonary function test
  • Women during pregnancy or breast-feeding
  • Severe mental disorder
  • Participating in other clinical studies simultaneously
  • Refusing to sign the informed consent for the study
  • Peritoneal implant or other distant metastases by intraoperative exploration
  • Unresectable due to tumor reasons by intraoperative exploration
  • Distal gastric cancer surgery cannot be performed after intraoperative exploration
  • Duodenal bulb has been invaded by tumor or gastroduodenostomy cannot be performed due to additional surgical resection cause by positive intraoperative frozen margin

Trial locations and contacts

1 site in 1 country.

China1 site
  • West China Hospital, Sichuan University

    Chengdu, Sichuan, 610041

Other trials in China

About this study

Official title: Safety and Feasibility of Double-Stapling End-to-End Gastroduodenostomy Billroth-I Anastomosis in Laparoscopy-Assisted Surgery for Locally Advanced Distal Gastric Cancers: A Prospective Cohort Study

The purpose of this study is to explore the clinical application value of Double-Stapling End-to-End Gastroduodenostomy Billroth-I Anastomosis in Laparoscopy-Assisted Surgery for Locally Advanced Distal Gastric Cancers.

Read the detailed description

As one of the core contents of gastric cancer surgery, the choice of digestive tract reconstruction method has always been the focus of clinical research in gastric cancer surgery. There are many alternative methods of digestive tract reconstruction at present, but there is no absolute superiority among various reconstruction methods. According to the individual characteristics of patients, the selection of appropriate digestive tract reconstruction methods should be an important direction in the future research field of digestive tract reconstruction.

There are many methods of digestive tract reconstruction in distal gastrectomy, including Billroth-I anastomosis, Billroth-II anastomosis and Roux-en-Y anastomosis. However, the standard method of reconstruction after distal subtotal gastrectomy does not reach a consensus. According to Korean Practice Guideline for Gastric Cancer 2018, gastroduodenostomy and gastrojejunal anastomosis are recommended after distal subtotal gastrectomy for middle-low gastric cancer, but the priority of different surgical procedures is not clarified. The conclusion is that there is no significant difference between the Billroth-I, Billroth-II and Roux-en-Y in postoperative quality of life, nutritional status and long-term prognosis of patients. Roux-en-Y anastomosis has a lower incidence of bile reflux, but a higher incidence of delayed gastric emptying compared with Billroth-I and Billroth-II. Similarly, the Japanese gastric cancer treatment guidelines in 2018 did not specify the priority of reconstruction methods after distal gastrectomy. In China, the 2022 CSCO guidelines for the diagnosis and treatment of gastric cancer also did not specify the priority of reconstruction methods, pointing out that alternative reconstruction methods include Billroth-I, Billroth-II combine with Braun anastomosis, Roux-en-Y anastomosis, and jejunal interposition. However, the number of alternative methods indicates that no ideal reconstruction method has absolute advantages. Therefore, in clinical practice, the specific choice of digestive tract reconstruction method often needs to be determined by considering many factors, including the location of the primary tumor, tumor stage, lymph node condition, anatomical variation and patient's economic situation, etc., which are important factors affecting the choice of digestive tract reconstruction method.

With the development of laparoscopic technique in recent years, totally laparoscopic digestive tract reconstruction has become a hot spot in the surgical treatment of gastric cancer. Laparoscopic digestive tract reconstruction has smaller incision and less trauma, which is a higher-level laparoscopic surgery pursued by surgeons. However, for patients undergoing radical gastrectomy for distal gastric cancer, totally laparoscopic distal gastroduodenal anastomosis is technically difficult. Delta anastomosis was proposed by Professor Kannaya in Japan in 2002. In this technique, the functional end to end anastomosis of the posterior wall of the remnant gastroduodenal was completed by using endoscopic linear staplers under totally laparoscopy, and the suture nails inside the anastomosis were triangular. It is a widely used functional end to end anastomosis of remnant gastroduodenum after distal gastrectomy under totally laparoscopic surgery. However, because of the operation in the duodenum and stomach from broken should meet the requirements of R0 resection of tumor, proper anastomotic tension, and blood supply of free longer duodenal stump, its restrictive factors, poor controllability, security is still not widely recognized, it can only be carried out in centers with rich experience in laparoscopic surgery, and it is more suitable for early cases of gastric Antrum.

In 2016, Professor Changming Huang found that modified Delta anastomosis is safe and feasible in early gastric cancer, but caution is still needed for locally advanced gastric cancer, its incidence of postoperative complications and anastomotic leakage was significantly higher than that of laparoscopic-assisted Billroth-I anastomosis.

In 1995, Oka et al. reported the use of circular stapler for functional end to end anastomosis of remnant gastroduodenum in open distal gastric cancer radical resection. In 2004, they reported the results of 221 cases, showing that this anastomosis was clinically safe and reliable. In 2007, Yang et al. in Korea confirmed that functional end to end anastomosis was safe and feasible in 933 cases of distal gastric cancer, with similar short-term outcomes compared with Billroth-II anastomosis. However, the clinical staging of gastric cancer patients in Japan and Korea is mainly early stage, but in China, the clinical staging of gastric cancer patients is mostly advanced stage.

In conclusion, traditional Billroth-I end-to-side anastomosis and Delta anastomosis require an additional residual gastric tissue of at least 3cm. In addition, the safe margin of the broken end of advanced gastric cancer requires a distance of at least 3-5 cm from the tumor, which often leads to higher anastomotic tension and significantly increases the risk of anastomotic leakage. Therefore, we propose a new technique for gastrointestinal reconstruction in laparoscopic distal radical gastrectomy in locally advanced gastric cancer: Double-Stapling End-to-End Gastroduodenostomy Billroth-I Anastomosis in Laparoscopy-Assisted Surgery. After previous practice, this anastomotic method can not only ensure a safe surgical margin, but also retain more residual stomach, so as to effectively solve the problem of anastomotic tension. It is a safe, simple, physiological and economic anastomotic method.

Keywords
anastomotic leakage, laparoscopy-assisted surgery, double-stapling end-to-end gastroduodenostomy, Billroth-I anastomosis, anastomotic stenosis
Medical subject headings
Anastomotic Leak

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Anastomotic complications

    The anastomotic complications are defined as the event observed within 30 days after surgery, including anastomotic stenosis, anastomotic bleeding, and anastomotic leakage.

    Measured: up to 1-30 Days after surgery

  2. Intraoperative situation

    Operation time, anastomotic reconstruction time, operative blood loss, completed proportion of laparoscopic surgery, positive rate of Intraoperative frozen margin pathology, anastomotic tension, the distance between proximal and distal of resection margin, the incidence of complication in surgery are used to access the intraoperative situation.

    Measured: on the day of surgery

  3. Postoperative nutritional status and quality of life

    The variation of weight, cholesterol and albumin on postoperative 30 days are used to access the postoperative nutritional status and quality of life.

    Measured: up to 1-30 Days after surgery

Secondary outcomes (4)
  1. Length of hospital stay

    The time between end of surgery and written discharge ticket

    Measured: up to 1-30 Days after surgery

  2. Cost of hospitalization

    The fees paid during the course of this hospitalization

    Measured: up to 1-30 Days after hospital admission

  3. Other postoperative complications

    Other postoperative complications are defined as events other than anastomotic complications occurring within 30 days after surgery.

    Measured: up to 1-30 Days after surgery

  4. Postoperative intestinal function recovery time

    The time between end of surgery and first bowel movement

    Measured: up to 1-6 Days after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2022
  2. Study start14 Sep 2017
  3. Primary completion6 Dec 2025
  4. Study completion6 Dec 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100 participants (actual)
Target duration
30 Days
IDs, dates and publications
ClinicalTrials.gov ID
NCT05545293
Sponsor's protocol ID
YZhou
Status last verified
Jun 2026
First submitted
14 Sep 2022
Last updated
11 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Nishizaki D, Ganeko R, Hoshino N, Hida K, Obama K, Furukawa TA, Sakai Y, Watanabe N. Roux-en-Y versus Billroth-I reconstruction after distal gastrectomy for gastric cancer. Cochrane Database Syst Rev. 2021 Sep 15;9(9):CD012998. doi: 10.1002/14651858.CD012998.pub2.

    PubMed 34523717
  • Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021 Jan;24(1):1-21. doi: 10.1007/s10120-020-01042-y. Epub 2020 Feb 14. No abstract available.

    PubMed 32060757
  • Cai Z, Zhou Y, Wang C, Yin Y, Yin Y, Shen C, Yin X, Chen Z, Zhang B. Optimal reconstruction methods after distal gastrectomy for gastric cancer: A systematic review and network meta-analysis. Medicine (Baltimore). 2018 May;97(20):e10823. doi: 10.1097/MD.0000000000010823.

    PubMed 29768387
  • Jin HE, Kim MS, Lee CM, Park JH, Choi CI, Lee HH, Min JS, Jee YS, Oh J, Chae H, Choi SI, Lee YT, Kim JH, Huang H, Park S. Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial. Eur J Surg Oncol. 2019 Dec;45(12):2231-2240. doi: 10.1016/j.ejso.2019.06.030. Epub 2019 Jun 22.

    PubMed 31262598
  • Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg. 2002 Aug;195(2):284-7. doi: 10.1016/s1072-7515(02)01239-5. No abstract available.

    PubMed 12168979
  • Lin M, Zheng CH, Huang CM, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Cao LL, Tu RH. Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case-control and case-matched study. Surg Endosc. 2016 Dec;30(12):5245-5254. doi: 10.1007/s00464-016-4872-3. Epub 2016 Mar 23.

    PubMed 27008576
  • Oka M, Maeda Y, Ueno T, Iizuka N, Abe T, Yamamoto K, Ogura Y, Masaki Y, Suzuki T. A hemi-double stapling method to create the Billroth-I anastomosis using a detachable device. J Am Coll Surg. 1995 Oct;181(4):366-8. No abstract available.

    PubMed 7551332
  • Kuwabara Y, Shinoda N, Sato A, Kimura M, Ishiguro H, Sugiura H, Tanaka T, Ando T, Fujii Y, Fujii Y. Billroth I gastroduodenostomy using a hemi-double stapling technique. J Am Coll Surg. 2004 Apr;198(4):670-2. doi: 10.1016/j.jamcollsurg.2003.11.016. No abstract available.

    PubMed 15051021
  • Park SH, Kang MJ, Yun EH, Jung KW. Epidemiology of Gastric Cancer in Korea: Trends in Incidence and Survival Based on Korea Central Cancer Registry Data (1999-2019). J Gastric Cancer. 2022 Jul;22(3):160-168. doi: 10.5230/jgc.2022.22.e21.

    PubMed 35938363
  • Yang HK, Lee HJ, Ahn HS, Yoo MW, Lee IK, Lee KU. Safety of modified double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy. J Surg Oncol. 2007 Dec 1;96(7):624-9. doi: 10.1002/jso.20883.

    PubMed 17708549

Questions about this trial

What is this clinical trial studying?

An observational study of Advanced Gastric Carcinoma, run by West China Hospital at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Anastomotic complications (time frame: up to 1-30 Days after surgery). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05545293, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jun 2026.

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