Comparison Between Two Methods of Pancreatic Transection in Distal Pancreatectomy

NCT ID: NCT03880773

Last Updated: 2019-03-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

152 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-01

Study Completion Date

2020-12-31

Brief Summary

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Several systematic reviews have investigated the management of the pancreatic stump in order to reduce the postoperative pancreatic fistula (POPF) rate after distal pancreatectomy (DP). The appropriate closure technique of the pancreatic stump is still debated. There is no published experience about the comparison of the Endo GIA Reinforced Reload with Tri-Staple Technology (TS) versus Harmonic Focus (US) after distal pancreatectomy (DP) regarding the reduction of POPF.

The investigators want to compare the incidence of clinically-relevant POPF (CR-POPF) after DP, depending upon the transection technique (TS versus US).

This is a randomized controlled, multicenter, patient-blinded, superiority trial. This protocol was designed according to the SPIRIT guidelines.

Two groups of 76 patients (152 in total) with an indication for elective minimally invasive or open DP for a lesion of the body-tail of the pancreas. The two techniques analyzed are Endo GIA Reinforced Reload with Tri-Staple Technology (TS) and Harmonic Focus (US) as control.

The primary endpoint is to evaluate the incidence of CR-POPF rate after DP. Secondary endpoints are intraoperative outcomes (blood loss, operative time and conversion of the minimally invasive procedure), postoperative outcomes (complications rate; hospitalization parameters to 90 days; mortality) and treatment costs.

Detailed Description

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Conditions

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Pancreatic Fistula Distal Pancreatectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Stapler

Group Type EXPERIMENTAL

Stapler

Intervention Type DEVICE

for transection of the pancreas and pancreatic stump treatment

ultrasonic shears

Group Type ACTIVE_COMPARATOR

ultrasonic shears

Intervention Type DEVICE

for transection of the pancreas and pancreatic stump treatment

Interventions

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Stapler

for transection of the pancreas and pancreatic stump treatment

Intervention Type DEVICE

ultrasonic shears

for transection of the pancreas and pancreatic stump treatment

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Scheduled for elective DP via a minimally invasive (laparoscopic or robotic) or open technique, either preserving the spleen or with splenectomy, depending on the diagnosis/nature of the tumor
* ASA score \< 4
* Ability of the subject to understand character and individual consequences of the clinical trial
* Written informed consent

Exclusion Criteria

* Pancreas thickness \>17mm measured at the intraoperative ultrasound at the pancreatic transection level
* Metastatic disease
* Kidney or adrenal gland resection
* Arterial resection (celiac axis, superior mesenteric artery, hepatic artery)
* Intestinal resections and anastomoses or stoma
* Acute necrotizing and chronic pancreatitis
* Immune suppressed patients
* Pregnant women
* Patients with contraindications for distal pancreatectomy
* Impaired mental state or language problems
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Ospedaliera Universitaria Integrata Verona

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Ospedale Policlinico GB Rossi

Verona, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Erica Secchettin

Role: CONTACT

0458126254

Facility Contacts

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Luca Landoni, MD

Role: primary

0458126254 ext. 0039

References

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Ban D, Shimada K, Konishi M, Saiura A, Hashimoto M, Uesaka K. Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg. 2012 Aug;36(8):1866-73. doi: 10.1007/s00268-012-1595-z.

Reference Type BACKGROUND
PMID: 22526040 (View on PubMed)

Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y, Tominaga M, Ku Y, Yamamoto YM, Kuroda Y. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg. 1999 May;86(5):608-11. doi: 10.1046/j.1365-2168.1999.01120.x.

Reference Type BACKGROUND
PMID: 10361178 (View on PubMed)

Kleeff J, Diener MK, Z'graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Muller MW, Friess H, Buchler MW. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007 Apr;245(4):573-82. doi: 10.1097/01.sla.0000251438.43135.fb.

Reference Type BACKGROUND
PMID: 17414606 (View on PubMed)

Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005 May;92(5):539-46. doi: 10.1002/bjs.5000.

Reference Type BACKGROUND
PMID: 15852419 (View on PubMed)

Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Buchler MW. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011 Apr 30;377(9776):1514-22. doi: 10.1016/S0140-6736(11)60237-7.

Reference Type BACKGROUND
PMID: 21529927 (View on PubMed)

Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, Jiang JX, Hu J, Wang M, Qin RY. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg. 2015 Jan;102(1):4-15. doi: 10.1002/bjs.9653. Epub 2014 Nov 12.

Reference Type BACKGROUND
PMID: 25388952 (View on PubMed)

Kim H, Jang JY, Son D, Lee S, Han Y, Shin YC, Kim JR, Kwon W, Kim SW. Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy. Medicine (Baltimore). 2016 Aug;95(35):e4441. doi: 10.1097/MD.0000000000004441.

Reference Type BACKGROUND
PMID: 27583852 (View on PubMed)

Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL, Miao Y. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep. 2017 Mar 15;7(1):185. doi: 10.1038/s41598-017-00311-8.

Reference Type BACKGROUND
PMID: 28298641 (View on PubMed)

Other Identifiers

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TRUDY

Identifier Type: -

Identifier Source: org_study_id

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