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You J, Zhang J, Cai H, Wang X, Wang H, Li Y, Yu C, Wang L, Zhou X, Peng B, Cai Y. Extended pancreatic neck transection versus conventional pancreatic neck transection during laparoscopic pancreaticoduodenectomy (LPDEXCEPT): protocol for a multicentre superiority randomised controlled trial. BMJ Open 2024; 14:e078092. [PMID: 38199635 PMCID: PMC10806631 DOI: 10.1136/bmjopen-2023-078092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) remains one of the most severe complications of laparoscopic pancreaticoduodenectomy (LPD). Theoretically, transecting the pancreatic neck more distally has both advantages (more blood supply, and more central pancreatic duct) and disadvantages (maybe smaller the pancreatic duct) in preventing POPF. This theoretical contradiction pushed us to organise this trial to explore the impact of the level of pancreatic transection in clinical practice. We conduct this randomised trial with the hypothesis that extended pancreatic neck transection has superiority to conventional pancreatic neck transection. METHODS AND ANALYSIS The LPDEXCEPT (Extended pancreatic neck transection versus conventional pancreatic neck transection during laparoscopic pancreaticoduodenectomy) trial is a multicentre, randomised-controlled, open-label, superiority trial in 4 centres whose annual surgical volume for LPD is more than 25 cases with pancreatic surgeons who had completed their learning curve. A total of 154 patients who meet the inclusive and exclusive criteria are randomly allocated to the extended pancreatic neck transection group or conventional pancreatic neck transection group in a 1:1 ratio. The stratified randomised block design will be applied, with stratified factors are surgical centre and the diameter of the main pancreatic duct measured by preoperative CT scan (preMPD). The primary outcome is the incidence of the clinically relevant pancreatic fistula. ETHICS AND DISSEMINATION Ethics Committee on Biomedical Research of West China Hospital of Sichuan University has approved this trial in March 2023 (approval no. 2023-167). Results of this trial will be published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER NCT05808894.
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Affiliation(s)
- Jiaying You
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- WestChina-California Research Center for Predictive Intervention, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jing Zhang
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - He Cai
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Xin Wang
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Hongjian Wang
- West China School of Public Health, Sichuan University West China Fourth Hospital, Chengdu, China
| | - Yongbin Li
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Sichuan University West China Hospital, Chengdu, China
| | - Chao Yu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lei Wang
- Department of Pancreatic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xu Zhou
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Jinan, China
| | - Bing Peng
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yunqiang Cai
- Division of Pancreatic Surgery, Department of General Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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