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Pancrelipase

Pancreatin

The patients who included this group will undergo conventional pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD). We will identify and isolate superior mesenteric vein (SMV) before pancreatic resection. The surgeon will dissect tissue around superior mesenteric artery (SMA) and uncinate process of pancreas along the SMA.

The patients who included this group will undergo PD or PPPD including total pancreatic mesopancreas excision and superior mesenteric artery approach. Before pancreatic transection, the surgeon will isolate superior mesenteric vein (SMV) and superior mesenteric artery (SMA). And the surgeon will dissect nerve plexus and lymph node around SMA. inferior pancreaticoduodenal artery (IPDA) and first jejunal artery will be identified and the surgeon will ligate according to surgical margin. Anastomosis will be performed as usual manners.

In this subgroup, the surgeon will perform pancreaticoduodenectomy without isolation of superior mesenteric artery and dissection of nerve plexus and lymph node around superior mesenteric artery.

conventional pancreaticoduodenectomy

In this subgroup, the surgeon will identify and isolate superior mesenteric artery before pancreatic transection, they dissect soft tissues including nerve plexus and node around superior mesenteric artery.

total mesopancreas excision including superior mesenteric artery first approach

Woohyung Lee, MD.

Woohyung Lee, MD

Song-Cheol Kim, MD.PhD

This study is aimed to evaluate difference of the 2 year recurrence free survival after pancreaticoduodenectomy for pancreatic cancer between artery-first approach and conventional procedure groups.

The patients will be divided into 2 groups

conventional group: The patients who included this group will undergo conventional pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD). We will identify and isolate superior mesenteric vein (SMV) before pancreatic resection. The surgeon will dissect tissue around superior mesenteric artery (SMA) and uncinate process of pancreas along the SMA.

Experimental group:

The patients who included this group will undergo PD or PPPD including total pancreatic mesopancreas excision and superior mesenteric artery approach. Before pancreatic transection, the surgeon will isolate superior mesenteric vein (SMV) and superior mesenteric artery (SMA). And the surgeon will dissect nerve plexus and lymph node around SMA. inferior pancreaticoduodenal artery (IPDA) and first jejunal artery will be identified and the surgeon will ligate according to surgical margin. Anastomosis will be performed as usual manners.

Postoperative manage is same in two groups. The investigators will compared 2 years recurrence free survival rate between conventional and experimental groups.

Usefulness of the Artery First Approach in Pancreatic Cancer Surgery

A Prospective Randomized Study of the Usefulness of the Artery First Approach in Pancreatic Cancer With Pancreaticoduodenectomy

locoregional or systemic tumor recurrence after surgery within 2 years

Microscopic tumor clearance after surgery in pathologic result

locoregional recurrence: around SMA, celiac axis, remnant pancreas, systemic recurrence: liver, lung, bone

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Usefulness of the Artery First Approach in Pancreatic Cancer Surgery	NCT04136522	Pancreatic Canc... Margin, Tumor-F... Surgery Site Fi... Recurrence Tumo...	conventional pa... total mesopancr...	20 Years -	Asan Medical Center
Usefulness of the Artery First Approach in Pancreatic Cancer Surgery	NCT04136522	Pancreatic Canc... Margin, Tumor-F... Surgery Site Fi... Recurrence Tumo...	conventional pa... total mesopancr...	20 Years -	Asan Medical Center
Usefulness of the Artery First Approach in Pancreatic Cancer Surgery	NCT04136522	Pancreatic Canc... Margin, Tumor-F... Surgery Site Fi... Recurrence Tumo...	conventional pa... total mesopancr...	20 Years -	Asan Medical Center

Spots Global Cancer Trial Database for surgery site fistula