The comparison of surgical therapies for adenocarcinoma of the gastroesophageal junction: transthoracic esophagectomy versus transhiatal extended gastrectomy
Résumé de l'étude
This study investigates the best possible surgical therapy for tumors located at the junction of the esophagus and stomach. Esophageal tumors are typically surgically treated by "esophagectomy" with stomach elevation. In this procedure, a large part of the esophagus along with the esophageal-stomach junction is removed. The stomach is shaped into a tube through an abdominal access, which is then connected to the remaining esophagus via a thoracic access. For tumors in the stomach, a "transhiatal extended gastrectomy" is performed. In this procedure, the entire stomach along with the esophageal-stomach junction is removed through an abdominal access, and a connection between the esophagus and small intestine is established. It remains unclear which procedure is best for tumors at the junction between the esophagus and stomach. Both procedures allow for complete tumor removal and are recommended in current treatment guidelines as equivalent treatment methods. The aim of the CARDIA study is to compare the two surgical approaches in terms of healing rates and resulting quality of life. This should enable the best possible surgical procedure to be offered to all patients with tumors of the esophageal-stomach junction.
(BASEC)
Intervention étudiée
This study compares "esophagectomy" with stomach elevation and "transhiatal extended gastrectomy". In "esophagectomy", which is the removal of the esophagus, the upper part of the stomach as well as a large part of the esophagus is removed. To restore continuity, a tube is formed from the remaining stomach, which is pulled into the thoracic cavity and connected to the remaining part of the esophagus. Access is achieved through both the abdominal cavity and the thoracic cavity. In "gastrectomy", which is the removal of the stomach, the entire stomach as well as the lower part of the esophagus is removed. To restore continuity, the remaining end of the esophagus is connected to the small intestine. Access is achieved in this procedure only through the abdominal cavity.
(BASEC)
Maladie en cours d'investigation
This study investigates esophageal carcinomas. Their incidence has significantly increased in recent decades. This study focuses on so-called "adenocarcinomas", which are malignant tumors arising from glandular epithelial cells. A particular form of these carcinomas involves tumors at the junction of the esophagus and stomach. In most cases, these tumors are treated with a combination of chemotherapy, possibly with radiation, followed by surgery.
(BASEC)
Patients with an adenocarcinoma of the gastroesophageal junction type II are included. The tumor and any affected lymph nodes must be removable by both transthoracic esophagectomy and transhiatal extended gastrectomy. Furthermore, patients must be in good condition, i.e., have good heart, lung, kidney, and liver function. For women of childbearing age, a negative pregnancy test must be present. Of course, a written consent form must also be provided.
(BASEC)
Critères d'exclusion
Patients with another type of tumor or tumor localization are excluded. Additionally, patients with surgically unresectable tumors or distant metastases (e.g., in the liver) are excluded. Furthermore, patients with clinically significant heart or lung diseases are excluded.
(BASEC)
Lieu de l’étude
Bâle
(BASEC)
Sponsor
Sponsor: University of Cologne, Germany Sponsor's representative in Switzerland: Clarunis - Universitäres Bauchzentrum Basel
(BASEC)
Contact pour plus d'informations sur l'étude
Personne de contact en Suisse
Beat Müller
0041-61-777-75-75
viszeralchirurgie@clutterclarunis.chClarunis - Universitäres Bauchzentrum Basel
(BASEC)
Informations générales
Universitätsklinik Köln Klinik und Poliklinik für Allgemein- Viszeral- und Tumorchirurgie
+49-221-478-4801
cardia.trial@uk-koeln.de(ICTRP)
Informations scientifiques
Universitätsklinik Köln Klinik und Poliklinik für Allgemein- Viszeral- und Tumorchirurgie
+49-221-478-4801
cardia.trial@uk-koeln.de(ICTRP)
Nom du comité d'éthique approbateur (pour les études multicentriques, uniquement le comité principal)
Ethikkommission Nordwest- und Zentralschweiz EKNZ
(BASEC)
Date d'approbation du comité d'éthique
03.08.2023
(BASEC)
Identifiant de l'essai ICTRP
DRKS00016923 (ICTRP)
Titre officiel (approuvé par le comité d'éthique)
Surgery for adenocarcinoma of the gastroesophageal junction (GEJ) type II: Transthoracic esophagectomy vs. transhiatal extended gastrectomy (BASEC)
Titre académique
Surgery for adenocarcinoma of the gastroesophageal junction (GEJ) type II:Transthoracic esophagectomy vs. transhiatal extended gastrectomy. - CARDIA Trial (ICTRP)
Titre public
Surgery for adenocarcinoma of the gastroesophageal junction (GEJ) type II:Transthoracic esophagectomy vs. transhiatal extended gastrectomy. (ICTRP)
Maladie en cours d'investigation
;C16.0 - Malignant neoplasm: Cardia
(ICTRP)
Intervention étudiée
Intervention 1: Transthoracic esophagectomy (removal of the esophagus and intrathoracic connection of the esophagus to the stomach) Intervention 2: Transhiatal extended gastrectomy (Removal of the stomach and the lower part of the esophagus with esophageal jejunostomy)
(ICTRP)
Type d'essai
interventional (ICTRP)
Plan de l'étude
Allocation: Randomized controlled trial;. Masking: Open (masking not used). Control: Active control (effective treament of control group). Assignment: Parallel. Study design purpose: Treatment;
(ICTRP)
Critères d'inclusion/exclusion
Inclusion criteria: • Histologically proven adenocarcinoma of the GEJ type II
• Non-metastatic tumor, resectable by both transthoracic esophagectomy and transhiatal extended gastrectomy according to the local surgical investigator
• Age = 18
• ECOG Eastern Cooperative Oncology Group (ECOG) performance status 0–2
• ASA 50% (determined by echocardiography)
• Adequate respiratory function (pulmonary function tests only necessary in symptomatic patients) with FEV1>/= 1.5 l/s
• Adequate bone marrow function (white blood cells > 3x10^9 /l; hemoglobin > 9 g/dl; platelets > 100x10^9 /l), renal function (glomerular filtration rate >60 ml/min), and liver function (total bilirubin < 1.5x upper level of normal (ULN), aspartate transaminase (AST) < 2.5x ULN and alanine transaminase (ALT) < 3x ULN)
• Written informed consent
(ICTRP)
Exclusion criteria: • Tumors of squamous, adenosquamous or another non-adenocarcinoma histology
• Advanced inoperable or metastatic GEJ type II adenocarcinoma
• GEJ type II adenocarcinoma staged cT4b, M+
• GEJ type II cT4a evaluated as not curatively resectable by the local surgical investigator
• Histologically proven adenocarcinoma of the GEJ type I and III
• Severe tumor stenosis preventing endoscopic tumor classification
• Tumor expanding more than 5 cm proximal of the GEJ
• Tumor resectable only by transthoracic esophagectomy or only by transhiatal extended gastrectomy, according to the local surgical investigator
• Positive lymph nodes only resectable by transthoracic esophagectomy (i.e. in the mid-upper mediastinum) or only resectable by transhiatal extended gastrectomy according to the local surgical investigator.
• Patients with locally advanced tumors (T3-T4 or N+) who did not receive chemotherapy (FLOT) preoperatively or received more or less than the allowed 4 cycles of chemotherapy
• Clinically significant (active) cardiac disease (e.g. symptomatic coronary artery disease or myocardial infarction within last 12 months)
• Clinically significant lung disease (forced expiratory volume in one second (FEV1) < 1.5 l/s)
• Pregnant women and nursing mothers
• Persons with any kind of dependency on the principal investigator or employed by the sponsor or principal investigator
• Legally incapacitated persons
• Persons held in an institution by legal or official order
(ICTRP)
Critères d'évaluation principaux et secondaires
Overall survival (Follow-up up to 60 months after discharge)
(ICTRP)
Complete (R0) resection, post-operative complications according to the Dindo-Clavien classification, number and Tumor Infiltration of lymph nodes at dissection, quality of life (EORTC QLQ-C30, -STO22, -OG25 after 3, 6, 12, 18, 24 months), cost-effectiveness
(ICTRP)
Date d'enregistrement
02.08.2019 (ICTRP)
Inclusion du premier participant
16.04.2020 (ICTRP)
Sponsors secondaires
non disponible
Contacts supplémentaires
Christiane Bruns, cardia.trial@uk-koeln.de, +49-221-478-4801, Universitätsklinik Köln Klinik und Poliklinik für Allgemein- Viszeral- und Tumorchirurgie (ICTRP)
ID secondaires
19-1376 (ICTRP)
Résultats-Données individuelles des participants
No
(ICTRP)
Informations complémentaires sur l'essai
http://www.drks.de/DRKS00016923 (ICTRP)
Résultats de l'essai
Résumé des résultats
non disponible
Lien vers les résultats dans le registre primaire
non disponible