Feasibility of Enhanced Recovery After Surgery Without Prophylactic Abdominal Drainage Tubes After Laparoscopic Distal Gastrectomy For Gastric Cancer

Official title

Feasibility of Enhanced Recovery After Surgery Without Prophylactic Abdominal Drainage Tubes After Laparoscopic Distal Gastrectomy For Gastric Cancer: A Prospective, Multicenter, Non-inferiority, Randomized, Open-label, Controlled Trial

Overview

This study aims to compare the effects of using prophylactic abdominal drainage tubes during Enhanced Recovery After Surgery (ERAS) in patients undergoing Laparoscopic Distal Gastrectomy (LDG) for gastric cancer through a multicenter non-inferiority randomized trial. The study is divided into two groups: 1. ERAS-tubeless group: The ERAS protocol without nasogastric decompression, nasojejunal feeding or prophylactic abdominal drainage tubes. 2. ERAS-tube group: the ERAS protocol with prophylactic abdominal drainage tubes, along with no nasogastric decompression or nasojejunal feeding tubes. Patients will be randomly assigned to the two groups in a 1:1 ratio, with the primary analysis based on the modified intention-to-treat population (mITT) and secondary analysis on the per-protocol (PP) population. Perioperative management will adhere to ERAS guidelines, and postoperative quality of life will be assessed using the EORTC QLQ-C30 questionnaire and QoR-15 scores. Preliminary training on the standard ERAS protocol is administered to all members in the team before the initiation of the study, ensuring in-group members to fully master the requirements and other related contents in the study. Data collectors, analysts, and outcome evaluators will remain blinded to group allocation. The findings of this study are expected to provide high-quality evidence on the feasibility of omitting prophylactic abdominal drainage in the context of ERAS, thereby contributing to the optimization of postoperative management strategies for gastric cancer surgery.

Interventions

• Procedure ERAS-tubeless group
  Nasogastric decompression tube is not placed preoperatively; If necessary, nasogastric decompression tube is placed after anesthesia induction during surgery and removed when the reconstruction is performed; No abdominal drainage and nasojejunal feeding tubes were placed intraoperatively; None of these 3 tubes were present postoperatively.
• Procedure ERAS-tube group
  Nasogastric decompression tube is not placed preoperatively; If necessary, nasogastric decompression tube is placed after anesthesia induction during surgery and removed when the reconstruction is performed; Nasojejunal feeding tube is not placed intraoperatively; 1 prophylactic abdominal drainage tube is placed at the duodenal stump for LDG and retained postoperatively.

Primary outcome measures

• Cumulative incidence of reoperation and/or percutaneous drainage placement by the 30th postoperative day. [Time frame: The 30th day after surgery]

Secondary outcome measures (9)

• Postoperative hospital stay [Time frame: It is expected to take 6 to 10 days]
• Overall 30 days morbidity or in hospital if longer than 30 days. [Time frame: The 30th day after surgery]
• 30 days readmission rate and overall 90 days mortality. [Time frame: Postoperative Day 30 and Day 90]
• EORTC QLQ-C30 [Time frame: Baseline, Postoperative Day 7 and Day 30]
• Quality of postoperative recovery. [Time frame: Baseline, Postoperative Day 1, Day 2, Day 3, Day 4, Day 5, and the Day of Discharge]
• Time to first ambulation, time to first flatus, and time to first liquid diet. [Time frame: It is expected to take 1 to 5 days.]
• NRS score. [Time frame: The period is from the day of surgery to the day of discharge, which is expected to be approximately 7 days.]
• PNI value. [Time frame: The period is from the day of surgery to the day of discharge, which is expected to be approximately 7 days.]
• Medical cost. [Time frame: The period is from the date of hospital admission to discharge, which is expected to take approximately 8 days.]

Eligibility criteria

Inclusion criteria

• Patients' age from 18 to 80 years old;
• Histopathologically confirmed gastric adenocarcinoma;
• Clinical tumor stage of cT1-4N0-3M0;
• Laparoscopic distal gastrectomy approach;
• ECOG score of 0-1;
• Written informed consent

Exclusion criteria

• Patients with severe concurrent illness or comorbid diseases;
• Patients with severe pyloric obstruction, recurrent or remnant gastric cancer; 3. Patients with perforation, or undergoing emergency surgery;

4\. Patients with a history of radiotherapy; 5. Patients undergoing complex abdominal surgeries other than laparoscopic cholecystectomy or appendectomy; 6. Patients with peritoneal, hepatic or ovarian metastasis, or simultaneous tumors in other parts of the body preoperatively and intraoperatively; 7. Patients with diabetes and poor recent glycemic control; 8. Patients with autoimmune diseases who have received corticosteroid treatment; 9. Patients with a BMI ≥30 kg/m2 or <18 kg/m2; 10. Patients with gastrointestinal hemorrhage and hemoglobin levels below 90 g/L; 11. Patients with hypoproteinemia and albumin levels below 30 g/L; 12. Patients with portal hypertension; 13. Patients with severe edema or dense fibrosis intraoperatively after neoadjuvant therapy; 14. Patients with intraoperative findings of duodenal invasion; 15. Patients with combined organ resection; 16. Reconstruction different from BillrothⅡand Braun anastomosis; 17. Patients with preoperative pathological examination inconsistent with postoperative result; 18. Declined to participate; 19. Patients with poor compliance and withdrew from the study halfway

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

China · 6 centers

• International Hospital of Pecking University — Beijing
• Fujian Medical University Union Hospital — Fuzhou
• Lanzhou University Second Hospital — Lanzhou
• Sun Yat-sen University Cancer Center Gansu Hospital — Lanzhou
• Zhejiang Cancer Hospital — Zhejiang
• The First Affiliated Hospital of Xi'an Jiaotong University — Xi'an

Identifiers

NCT: NCT07029269 · LanzhouU2H-2025A-540

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗