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Okada N, Kinoshita Y, Nishihara S, Kurotaki T, Sato A, Kimura K, Kushiya H, Umemoto K, Furukawa S, Yamabuki T, Takada M, Kato K, Ambo Y, Nakamura F. PYloroplasty versus No Intervention in GAstric REmnant REconstruction after Oesophagectomy: study protocol for the PYNI-GAREREO phase III randomized controlled trial. Trials 2023; 24:412. [PMID: 37337238 DOI: 10.1186/s13063-023-07435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND After esophagectomy for esophageal and esophagogastric cancer, more than half of patients have lost > 10% of their body weight at 12 months. In most cases, the gastric remnant is used for reconstruction after esophagectomy. One of the most serious nutritional complications of this technique is delayed gastric emptying caused by gastric remnant mobilization and denervation of the vagus nerve. The aim of the PYloroplasty versus No Intervention in GAstric REmnant REconstruction after Oesophagectomy (PYNI-GAREREO) trial is to analyze the clinical outcome of modified Horsley pyloroplasty (mH-P) as a method of preventing delayed gastric emptying. METHODS The PYNI-GAREREO trial is designed as an open randomized, single-center superiority trial. Patients will be randomly allocated to undergo gastric remnant reconstruction with mH-P (intervention group) or no intervention (control group) in parallel groups. All patients with esophageal cancer or esophagogastric cancer planning to undergo curative minimally invasive esophagectomy will be considered for inclusion. A total of 140 patients will be included in the study and randomized between the groups in a 1:1 ratio. The primary outcome is the body weight change at 6 months postoperatively, and the secondary outcomes are the nutritional status, postoperative complications, functional outcome, and quality of life until 1 year postoperatively. DISCUSSION We hypothesize that mH-P after minimally invasive esophagectomy more effectively maintains patients' nutritional status than no pyloroplasty. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000045104. Registered on 25 August 2021. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000051346 .
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Affiliation(s)
- Naoya Okada
- Department of Surgery and Center of Esophageal Diseases, Teine Keijinkai Hospital, 1-40 Maeda, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Yoshihiro Kinoshita
- Department of Surgery and Center of Esophageal Diseases, Teine Keijinkai Hospital, 1-40 Maeda, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Shoji Nishihara
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Takuma Kurotaki
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Aya Sato
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kotaro Kimura
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Hiroki Kushiya
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kazufumi Umemoto
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Shotaro Furukawa
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Takumi Yamabuki
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kentaro Kato
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Fumitaka Nakamura
- Department of Surgery, Teine Keijinkai Hospital, 1-40 Maeda1-12, Teine-Ku, Sapporo, Hokkaido, 006-8555, Japan
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