Patient case: 50-year-old male with pancreatic cancer; genetic feature: BRCA2

Clinical trial: Laparoscopic Versus Open Distal Pancreatectomy for Pancreatic Cancer: a Multicenter Randomized Controlled Trial

Summary: When pancreatic cancer of the body and tail is diagnosed, a distal pancreatectomy is planned. This operation can be performed with open surgery, or with laparoscopic surgery. This study is a multicenter randomized controlled trial to evaluate the operative outcomes and survival of open versus laparoscopic distal pancreatectomy for pancreatic cancer of the body and tail.

Detailed description: * Purpose
  To compare the safety and oncologic feasibility of open versus laparoscopic distal pancreatectomy for the treatment of pancreatic ductal adenocarcinoma (PDAC) of the body and tail.
  * Study method
  Multicenter prospective randomized controlled trial Noninferiority analysis Patients diagnosed with PDAC of the body and tail, without evidence of distant metastasis or direct invasion of adjacent organs, will be randomly allocated to either the open distal pancreatectomy group or the laparoscopic distal pancreatectomy group. Postoperative outcomes and survival data will be analyzed.
  * Number of subjects
  Sample size was calculated based on 2 year survival after pancreatectomy.
  pA: 2 year survival of open distal pancreatectomy pB: 2 year survival of laparoscopic distal pancreatectomy
  Null hypothesis: The 2 year survival of laparoscopic distal pancreatectomy is inferior to that of open distal pancreatectomy. H0: pA−pB≥δ
  Alternative hypothesis: The 2 year survival of laparoscopic distal pancreatectomy is not inferior to that of open distal pancreatectomy. H1: pA−pB<δ
  2 year survival of pancreatectomy (Shin et al, 2015) is 55.9% for open and 64.3% for laparoscopic distal pancreatectomy.
  When α=5%, 1-β=80%, δ=10%, and one-sided analysis is performed with a power of 80%, the required number of subjects is 111 for each group.
  With a drop rate of 10%, the final number of each group is 122, with a total of 244.
  * Primary and Secondary endpoints
  Primary endpoint: 2 year overall survival
  Secondary endpoint: R0 resection rate, 2 year disease free survival, 2 year recurrence rate, complication rate, postoperative hospital stay, operative time, estimated blood loss

Eligibility: Inclusion Criteria:
  -  Pancreatic ductal adenocarcinoma that is pathologically confirmed or shows characteristic radiologic features
  -  No evidence of distant metastasis
  -  No direct invasion of adjacent structures, with the exception of mesocolon or left adrenal gland
  -  Possible to achieve a negative margin from adjacent major vasculature (Common hepatic artery, superior mesenteric artery, celiac axis, superior mesenteric vein - portal vein)
  -  Eastern Cooperative Oncology Group (ECOG) performance score 0-2
  -  Patients with informed consent
  Exclusion Criteria:
  -  History of other malignancy (with the exception of more than 5 year interval, with no evidence of recurrence)
  -  Necessity of resection of other abdominal organs
  -  Recurrent pancreatic cancer
  -  Neoadjuvant chemotherapy
  -  Comorbidities with a high risk for general anesthesia
  -  Other subject whom the investigator deems inappropriate

Relevance to patient case: not relevant