Unique ID issued by UMIN | UMIN000041381 |
---|---|
Receipt number | R000047243 |
Scientific Title | Isolation procedure vs. conventional procedure during distal pancreatectosplenectomy for pancreatic cancer |
Date of disclosure of the study information | 2020/10/01 |
Last modified on | 2024/02/12 13:07:27 |
Isolation procedure vs. conventional procedure during distal pancreatectosplenectomy for pancreatic cancer
ISOP-DP trial
Isolation procedure vs. conventional procedure during distal pancreatectosplenectomy for pancreatic cancer
ISOP-DP trial
Japan |
Pancreatic cancer
Hepato-biliary-pancreatic surgery |
Malignancy
NO
In the distal pancreatectomy (including pancreatic tail resection) for invasive ductal carcinoma of the pancreas, we evaluate the usefulness of a procedure of firstly transection of splenic arteries and veins (the isolation procedure group) compared to a conventional procedure of transection of the splenic vein at the end.
Safety,Efficacy
2-year recurrence-free survival
Surgical data: Surgery time, blood loss, blood transfusion
Postoperative complications: Incidence of each Grade of pancreatic fistula, Incidence of delayed gastric excretion (DGE) Grade B/C, Incidence of intraperitoneal hemorrhage (PPH) Grade B/C, Incidence of all postoperative complications, Surgical death Proportion
Pathological diagnosis: ratio of tumor residual rate (R0, R1 rate), total number of resected lymph nodes, number of metastatic lymph nodes, lymph node ratio (number of metastatic lymph nodes/total number of resected lymph nodes)
Treatment results: Overall survival, recurrence-free survival, local recurrence rate
Interventional
Parallel
Randomized
Individual
Open -no one is blinded
Active
YES
YES
Institution is considered as adjustment factor in dynamic allocation.
NO
Central registration
2
Treatment
Maneuver |
In the conventional procedure group, first, the pancreatic body and tail and spleen are mobilized (mandatory procedure), and the regional lymph nodes of the body and tail of the pancreas, such as the hepatoduodenal mesentery (No12 lymph node) and the common hepatic artery perimeter (No8), are removed. (Recommended procedure) and dissection of lymph nodes (No14p) around SMA (Recommended procedure), and after dissection of the gastro-splenic ligament and pancreas, transection of the splenic vein at the end of the resection procedure (required procedure) . However, in order to prevent bleeding and secure a safe field of view, early pancreatotomy is allowed.
In the Isolation procedure group, the transection of the root of the splenic artery and the pancreatic transection are performed first, followed by the transection of the splenic vein (mandatory procedure). At that time, the branch from the splenic artery (dorsal pancreatic artery), the branch to the splenic vein (left gastric vein, inferior mesenteric vein), and short gastric arteriovenous are also disconnected as soon as possible (recommended procedure). An operation to lift up the pancreatic neck from the dorsal portal vein or superior mesenteric artery to expose the splenic vein (so-called tunneling) is allowed. After that, lymph node dissection such as hepatoduodenal mesentery (No12), common hepatic artery perimeter (No8), lymph node dissection around SMA (No14p) was performed (recommended procedure), and at the end of the resection operation, the pancreas body/tail and spleen are mobilized and removed (required procedure).
20 | years-old | <= |
Not applicable |
Male and Female
1) Resectable pancreatic cancer (Adenocarcinoma, adenosquamous cell carcinoma, mucinous carcinoma, and anaplastic carcinoma according to the 7th edition of the regulations for handling pancreatic cancer, excluding invasive intraductal papillary mucinous carcinoma (IPMC). However, preoperative biopsy. Is not required and allows clinical diagnosis), and a tail pancreatectomy or tail pancreatectomy is planned.
2) ASA-PS (American Society of Anesthesiology, General condition classification) is Class 1-3.
3) Age are over 20 years old.
4) He/she has sufficient judgment to understand the content of the research and has obtained written consent from the person himself/herself.
1) Patients who have not been diagnosed with resectable pancreatic cancer by image diagnosis at the initial diagnosis
2) Cases suspected of portal vein (superior mesenteric vein) invasion
3) Patients with severe ischemic heart disease
4) Patients with cirrhosis or active hepatitis requiring treatment
5) Patients with dyspnea requiring oxygen administration
6) Patients undergoing dialysis due to chronic renal failure
7) Cases in which arterial reconstruction of the superior mesenteric artery, common hepatic artery, celiac artery, etc. is considered necessary
8) Patients with strong suspected paraaortic lymph node metastasis
9) Active double cancer thought to affect adverse events and prognosis
10) Long-term oral steroids that may affect adverse events
11) Patients who are considered to have difficulty participating in the study due to psychosis or psychiatric symptoms.
12) Cases other than invasive pancreatic ductal carcinoma by preoperative biopsy. Invasive pancreatic ductal carcinoma is classified into four types, adenocarcinoma, adenosquamous cell carcinoma, mucinous carcinoma, and anaplastic carcinoma, in accordance with the 7th edition of the regulations for handling pancreatic cancer, and invasive intraductal papillary mucinous carcinoma (IPMC) is excluded. (However, preoperative biopsy is not mandatory.)
13) Patients who cannot use both iodine drugs and gadnium drugs due to severe drug allergy
14) Cases where the prescribed procedure is difficult due to history of upper abdominal surgery such as stomach, spleen, kidney, liver, transverse colon, retroperitoneum including pancreas and pancreatitis
100
1st name | Ken-ichi |
Middle name | |
Last name | Okada |
Wakayama Medical University
Second Department of Surgery
641-8510
Wakayama City, Kimiidera 811-1
0734472300
okada@wakayama-med.ac.jp
1st name | Ken-ichi |
Middle name | |
Last name | Okada |
Wakayama Medical University
Second Department of Surgery
641-8510
Wakayama City, Kimiidera 811-1
0734472300
okada@wakayama-med.ac.jp
Wakayama Medical University
Second Department of Surgery, Wakayama Medical University
Self funding
Clinical Study Support Center, Wakayama Medical University Hospital
Institutional Review Board of Wakayama Medical University
Wakayama City, Kimiidera 811-1
0734472300
warinri@wakayama-med.ac.jp
NO
和歌山県立医科大学附属病院(和歌山県)
富山大学附属病院(富山県)
広島大学病院(広島県)
大阪大学医学部附属病院(大阪府)
大阪市立大学医学部附属病院(大阪府)
奈良県立医科大学附属病院(奈良県)
近畿大学医学部附属病院(大阪府)
名古屋大学医学部附属病院(愛知県)
熊本大学病院(熊本県)
滋賀医科大学医学部附属病院(滋賀県)
神戸大学医学部附属病院(兵庫県)
2020 | Year | 10 | Month | 01 | Day |
Unpublished
No longer recruiting
2020 | Year | 08 | Month | 10 | Day |
2020 | Year | 09 | Month | 08 | Day |
2020 | Year | 10 | Month | 01 | Day |
2024 | Year | 09 | Month | 30 | Day |
2020 | Year | 08 | Month | 10 | Day |
2024 | Year | 02 | Month | 12 | Day |
Value
https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047243