Combined Resection vs. Separated Resection After Mobilization of Splenic Vein During Distal Pancreatectomy

Study Overview
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Brief Summary
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Eligible patients will be centrally randomized to either Arm A (resection of the splenic vein after isolation from the pancreatic parenchyma) or Arm B (co-resection of the vein together with the pancreas).

Detailed Description
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In distal pancreatectomy, it is customary to ligate and divide the splenic vein after isolating it from the pancreatic parenchyma. This is considered essential to prevent disruption of the stump of the splenic vein and the consequent intra-abdominal haemorrhage in the event of pancreatic fistula. This procedure can be technically demanding, especially when the vein is firmly embedded in the pancreatic parenchyma. The objective of this trial is to confirm the non-inferiority of resection of the splenic vein embedded in the pancreatic parenchyma compared with the conventional technique of isolating the splenic vein before resection during distal pancreatectomy using a mechanical stapler.

Official Title
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Comparison of Resection During Distal Pancreatectomy of the Splenic Vein Either Together With the Pancreatic Parenchyma or After Isolation: A Multicentre, Prospective, Randomized Phase III Trial

Conditions
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Pancreatic Neoplasms

Intervention / Treatment
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* Procedure: combined resection of the splenic vein
* Procedure: separated resection of the splenic vein


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elective open or laparoscopic distal pancreatectomy for diseases of the pancreatic body and tail ECOG Performance Status (PS) = 0-1 Age ≥ 20 years old Maintenance of functioning of the major organs (bone marrow, liver, kidney, lung, etc.) (a) White blood cells ≥ 2,500/mm3 (b) Haemoglobin ≥ 9.0 g/dL (c) platelets ≥ 100,000/mm3 (d) Total bilirubin ≤ 2.0 mg/dL (e) Creatinine ≤ 2.0 mg/dL (v) Sufficient judgement to understand the study and to provide written informed consent Exclusion Criteria: Splenic vein-preserving distal pancreatectomy Superior mesenteric vein or portal vein invasion Pancreatic trauma Preoperative inflammatory pancreatic disease (pancreatitis) Requirement of anti-coagulant treatment during or after surgery. Anti-coagulant treatment at 24 hrs after surgery is allowed. Severe ischemic cardiovascular disease Liver cirrhosis or active hepatitis Need for oxygen due to interstitial pneumonia or lung fibrosis Dialysis due to chronic renal failure Need for surrounding organ resection (stomach, colon, etc.), excluding the left adrenal gland and gall bladder Active multiple cancer that is thought to influence the occurrence of adverse events Difficulty with study participation due to psychotic disease or symptoms Inappropriate use of the stapler Inappropriate for the study objectives

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: separated resection of the splenic vein<br>separated resection of the splenic vein from the pancreatic parenchyma before ligation and division during distal pancreatectomy using mechanical staplers. | Procedure: separated resection of the splenic vein<br>* separated resection of the splenic vein from the pancreatic parenchyma before ligation and division during distal pancreatectomy using mechanical staplers.<br>|
| Experimental: combined resection of the splenic vein<br>combined resection of the splenic vein with the pancreatic parenchyma before ligation and division during distal pancreatectomy using mechanical staplers. | Procedure: combined resection of the splenic vein<br>* combined resection of the splenic vein with the pancreatic parenchyma before ligation and division during distal pancreatectomy using mechanical staplers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the incidence of pancreatic fsitula grade B/C |  | 6 months after operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the incidence of pancreatic fsitula of all grades |  | 6 months after operation | 
| the incidence of pancreatic fsitula grade C |  | 6 months after operation | 
| the incidenceof intra-abdominal haemorrhage |  | 6 months after operation | 
| the incidence of all complications |  | 6 months after operation | 
| comparison of the thickness of the resected pancreatic parenchyma with the incidence of PF grade B/C |  | 6 months after operation | 
| mortality |  | 6 months after operation | 
| the incidence of thrombosis of the splenic vein |  | 6 months after operation | 
| the operative time |  | during operation | 
| volume of blood loss |  | during operation | 
| thickness of the resected pancreatic parenchyma |  | during operation | 
| haemostasis of the staple line |  | during operation | 
| integrity of the staple line |  | during operation | 
| the incidence of pancreatic injury |  | during operation | 
| need for additional sutures to securely close the pancreatic stump |  | during operation | 
| time needed for pancreatic transection |  | during operation | 
| duration of drainage tube placement |  | 6 months after operation | 
| postoperative hospital stay duration |  | 6 months after operation | 
| the incidence of conversion from laparoscopic surgery to open surgery |  | during operation |