LRAMPS Versus LDP in Selected Early-stage Left-sided Pancreatic Cancer

Left-sided Pancreatic Cancer Clinical Trial

Official title:

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy Versus Laparoscopic Distal Pancreatosplecnectomy in Selected Left-sided Pancreatic Cancer: a Multicenter Randomized Controlled Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05939063
• Other study ID #: CSPAC-6
• Status: Recruiting
• Phase: N/A
• Start date: October 1, 2023
• Est. completion date: August 31, 2028

Study information

• Verified date: November 2023
• Source: Fudan University
• Contact: Xianjun Yu, MD, PhD
• Phone: +86-13801669875
• Email: yuxianjun[@]fudanpci.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This multicenter randomized controlled clinical trial proposed the criteria for selecting patients with early-stage left-sided pancreatic cancer and aimed to compare the perioperative and oncological outcomes of patients within the criteria who underwent laparoscopic radical antegrade modular pancreatosplenectomy versus laparoscopic distal pancreatosplenectomy.

Description:

Although prospective comparative studies are lacking, laparoscopic distal pancreatosplenectomy (LDP) was considered to be feasible, safe, and oncologically equivalent for treating pancreatic ductal adenocarcinoma (PDAC). However, the extent of posterior resection and the oncological safety of achieving complete N1 lymph node resection in LDP remain uncertain. Strasberg proposed radical antegrade modular pancreatosplenectomy (RAMPS) for the treatment of resectable left-sided PDAC and confirmed that this technique can achieve negative margins and satisfactory survival. Given the oncological equivalence of laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) and its advantages in short-term outcomes, several studies have assessed the feasibility of LRAMPS as the standard treatment for resectable left-sided PDAC. However, previous studies on LRAMPS have mostly included tumors staged T2 and above, and there is currently no research on the routine use of LRAMPS for early-stage tumors. We proposed the criteria for selecting patients with early-stage left-sided PDAC: (1) diameter ≤ 4 cm; (2) located ≥ 1 cm from the celiac trunk; (3) didn't invade the fascial layer behind the pancreas. This multicenter open-label randomized controlled clinical trial aims to compare the perioperative and oncological outcomes of patients within the criteria who underwent LRAMPS versus LDP.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 160
• Est. completion date: August 31, 2028
• Est. primary completion date: August 31, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Clinically diagnosed as resectable left-sided pancreatic cancer before surgery.

• Imaging tumor diameter = 4 cm.

• Located = 1cm from the celiac trunk.

• Tumor didn't invade the fascial layer behind the pancreas.

• Be able to comply with research protocol.

• Voluntary participation and signed informed consent.

Exclusion Criteria:

• Received neoadjuvant therapy.

• Presence of liver or other distant metastasis.

• Multifocal or recurrent disease.

• History of other malignancies.

• Simultaneously participating in other clinical trials.

Related Conditions & MeSH terms

• Left-sided Pancreatic Cancer
• Pancreatic Neoplasms

Intervention

Procedure:
• LRAMPS
For LRAMPS procedure, Gerota's fascia and perirenal fat capsule are removed, and the procedure is divided into anterior LRAMPS and posterior LRAMPS depending on whether the left adrenal gland is resected. The N1 station lymph nodes (i.e., groups 10, 11, and 18) in the body and tail of the pancreas are removed. If the tumor is located near the pancreatic body, the No. 9 lymph node group is additionally removed.
• LDP
For LDP procedure, the dissection plane is located behind the fusion fascia. The N1 station lymph nodes (i.e., groups 10, 11, and 18) in the body and tail of the pancreas are removed. If the tumor is located near the pancreatic body, the No. 9 lymph node group is additionally removed.

Locations

Country	Name	City	State
China	Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center	Shanghai	Shanghai

Sponsors (3)

Lead Sponsor	Collaborator
Fudan University	Qilu Hospital of Shandong University, The Third Affiliated Hospital of Soochow University

Country where clinical trial is conducted

China, 

References & Publications (14)

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de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M; Dutch Pancreatic Cancer Group. Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. Ann Surg. 2019 Jan;269(1):2-9. doi: 10.1097/SLA.0000000000002979. — View Citation

Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS. Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc. 2014 Oct;28(10):2848-55. doi: 10.1007/s00464-014-3537-3. Epub 2014 May 23. — View Citation

Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012 Jan;214(1):46-52. doi: 10.1016/j.jamcollsurg.2011.10.008. — View Citation

Sato S, Oba A, Kato T, Kobayashi K, Wu YHA, Ono Y, Sato T, Ito H, Inoue Y, Takahashi Y. Feasibility of laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) as a standard treatment for distal resectable pancreatic cancer. Langenbecks Arch Surg. 2023 May 30;408(1):217. doi: 10.1007/s00423-023-02942-0. — View Citation

Sivasanker M, Desouza A, Bhandare M, Chaudhari V, Goel M, Shrikhande SV. Radical antegrade modular pancreatosplenectomy for all pancreatic body and tail tumors: rationale and results. Langenbecks Arch Surg. 2019 Mar;404(2):183-190. doi: 10.1007/s00423-019-01763-4. Epub 2019 Feb 21. — View Citation

Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003 May;133(5):521-7. doi: 10.1067/msy.2003.146. — View Citation

Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007 Feb;204(2):244-9. doi: 10.1016/j.jamcollsurg.2006.11.002. Epub 2007 Jan 4. — View Citation

Sutton TL, Potter KC, Mayo SC, Pommier R, Gilbert EW, Sheppard BC. Complications in Distal Pancreatectomy versus Radical Antegrade Modular Pancreatosplenectomy: A Disease Risk Score Analysis Utilizing National Surgical Quality Improvement Project Data. World J Surg. 2022 Jul;46(7):1768-1775. doi: 10.1007/s00268-022-06545-6. Epub 2022 Apr 11. — View Citation

Takahashi A, Mise Y, Watanabe G, Yoshioka R, Ono Y, Inoue Y, Ito H, Takahashi Y, Kawasaki S, Saiura A. Radical antegrade modular pancreatosplenectomy enhances local control of the disease in patients with left-sided pancreatic cancer. HPB (Oxford). 2023 Jan;25(1):37-44. doi: 10.1016/j.hpb.2022.08.004. Epub 2022 Aug 20. — View Citation

Tang W, Zhang YF, Zhao YF, Wei XF, Xiao H, Wu Q, Du CY, Qiu JG. Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: A systematic review and meta-analysis. Int J Surg. 2022 Jul;103:106676. doi: 10.1016/j.ijsu.2022.106676. Epub 2022 May 13. — View Citation

van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, Alseidi A, Ateeb Z, Balzano G, Berrevoet F, Bjornsson B, Boggi U, Busch OR, Butturini G, Casadei R, Del Chiaro M, Chikhladze S, Cipriani F, van Dam R, Damoli I, van Dieren S, Dokmak S, Edwin B, van Eijck C, Fabre JM, Falconi M, Farges O, Fernandez-Cruz L, Forgione A, Frigerio I, Fuks D, Gavazzi F, Gayet B, Giardino A, Groot Koerkamp B, Hackert T, Hassenpflug M, Kabir I, Keck T, Khatkov I, Kusar M, Lombardo C, Marchegiani G, Marshall R, Menon KV, Montorsi M, Orville M, de Pastena M, Pietrabissa A, Poves I, Primrose J, Pugliese R, Ricci C, Roberts K, Rosok B, Sahakyan MA, Sanchez-Cabus S, Sandstrom P, Scovel L, Solaini L, Soonawalla Z, Souche FR, Sutcliffe RP, Tiberio GA, Tomazic A, Troisi R, Wellner U, White S, Wittel UA, Zerbi A, Bassi C, Besselink MG, Abu Hilal M; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS). Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. Ann Surg. 2019 Jan;269(1):10-17. doi: 10.1097/SLA.0000000000002561. — View Citation

Wu EJ, Kabir T, Zhao JJ, Goh BKP. Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy: A Meta-Analysis. World J Surg. 2022 Jan;46(1):235-245. doi: 10.1007/s00268-021-06328-5. Epub 2021 Oct 5. — View Citation

Zhang H, Li Y, Liao Q, Xing C, Ding C, Zhang T, Guo J, Han X, Xu Q, Wu W, Zhao Y, Dai M. Comparison of minimal invasive versus open radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic ductal adenocarcinoma: a single center retrospective study. Surg Endosc. 2021 Jul;35(7):3763-3773. doi: 10.1007/s00464-020-07938-1. Epub 2020 Oct 8. — View Citation

* Note: There are 14 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	R0 retroperitoneal margin rate	R0 retroperitoneal margin rate diagnosed by postoperative pathological examination.	From the date of surgery to 1 month after surgery.
Primary	R0 transection margin rate	R0 transection margin rate diagnosed by postoperative pathological examination.	From the date of surgery to 1 month after surgery.
Primary	Lymph node positive rate	Lymph node positive rate diagnosed by postoperative pathological examination.	From the date of surgery to 1 month after surgery.
Secondary	Perioperative complication rate	Adverse events that occur during or after the surgery, including the incidence of postoperative complications reported according to the Clavien-Dindo classification, clinical relevant postoperative pancreatic fistula (POPF), postoperative pancreatic hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate and mortality rate within 90 days after surgery.	Within 90 days after surgery.
Secondary	Life quality satisfaction evaluated according to EORTC C30 scale	The patient's health-related quality of life after surgical intervention. It includes physical, emotional, and social aspects of a patient's well-being. This study evaluated quality of life using a telephone survey and the EORTC C30 scales.	Through study completion, an average of 3 year.
Secondary	Recurrence-free survival (RFS)	The time of surgery to the time of tumor recurrence or death.	Through study completion, an average of 3 year.
Secondary	Overall survival (OS)	The time from the surgery to death from any cause.	Through study completion, an average of 3 year.