- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04253847
RAMPS VS SRPS for Pancreatic Body and Tail Adenocarcinoma
February 1, 2020 updated by: Yuanchi Weng, Ruijin Hospital
Radical Antegrade Modular Pancreatosplenectomy Versus Standard Retrograde Pancreatosplenectomy on the Survival and Prognosis for Resectable Body and Tail Pancreatic Ductal Adenocarcinoma
Two arms RCT is design, patients with pancreatic body or tail adenocarcinoma will be randomly assigned to the Radical Antegrade Modular Pancreaticosplenectomy (RAMPS) group or Standard Retrograde Pancreatosplenectomy (SRPS) group.
The primary objective is to evaluate the effect of RAMPS on the overall survival of patients with resectable body and tail pancreatic ductal adenocarcinoma.
And the secondary objective is to evaluate the disease-free survival, R0 resection rate, number of retrieved lymph nodes and perioperative outcomes like postoperative complication rate, severe complications, mortality and functional recovery time between the experimental group and control group.
Study Overview
Status
Not yet recruiting
Study Type
Interventional
Enrollment (Anticipated)
224
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Yuanchi Weng, MD
- Phone Number: +86-13774209138
- Email: wyuanchi@126.com
Study Contact Backup
- Name: Zhen Huo, PhD
- Phone Number: +86-15000082925
- Email: generalsurgeon@qq.com
Study Locations
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Shanghai
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Shanghai, Shanghai, China, 200025
- Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine
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Contact:
- Zhen Huo, PhD
- Phone Number: +86-15000082925
- Email: generalsurgeon@qq.com
-
Contact:
- Yuanchi Weng, MD.
- Phone Number: +86-13774209138
- Email: wyuanchi@126.com
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 18-80 years old;
- Resectable pancreatic body and tail ductal adenocarcinoma with both preoperative and intraoperative evaluation(refer to NCCN guideline 2018 of Pancreatic Cancer);
- ECOG Performance Status 0-1;
- Adenocarcinoma of pancreatic body and tail duct, without distant metastasis and ascites;
- The estimated survival time is ≥ 3 months;
- Follow-up in time and obey the research requirements;
- Be voluntary to this clinical trial and can sign the informed consent;
- Normal hematological index (Leukocyte, platelet, liver function, renal function, DIC, electrolyte index, Hb >10g/dL).
Exclusion Criteria:
- The patients with distant metastasis according to preoperative tumor staging;
- Patients with recurrent pancreatic ductal adenocarcinoma;
- The artery or vein is involved and could not be resected or reconstructed(according to preoperative evaluation or intraoperative evaluation after exploration);
- Patients with cardiopulmonary disfunction and cannot tolerate operation;
- The patients accepted neoadjuvant chemotherapy and radiotherapy before operation;
- Patients with other malignancies or hematopathy
- Before the operation, the total bilirubin was more than 250 μmol/L without preoperative biliary drainage or after biliary drainage, the total bilirubin was still more than 250 μmol/L;
- Pregnancy diagnosed, planned pregnancy and lactating female patients
- Refusal to sign consent.
- Intraoperative exclusion include:Tumor metastasis; not pancreatic primary disease; unresectable pancreatic body/tail adenocarcinoma
- Postoperative exclusion include: not pancreatic ductal adenocarcinoma according to pathological examination.
- Withdrawal of informed consent;
- Willingness to withdraw from the study.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: RAMPS group
Radical antegrade modular pancreatosplenectomy (RAMPS) includes the following aspects.
Firstly, the surgical approach is "antegrade", which means from the right to the left, the pancreatic neck will be transected at first and the spleen will be seperated at last.
Secondly, lymph nodes dissection includes not only the regional lymph nodes(No.10,11,18
lymph nodes), but also N1 station lymph nodes (N1: 6, 8a, 8p, 12a2/b2/p2, 13a/b, 14b/c/d, 14v, 17a/b), No.7, 9 lymph nodes, the lymph nodes anterior and left of superior mesenteric artery, as well as the peripheral nerve of celiac trunk.
Thirdly, the transection platform is in the pancreatic neck, which is mandatory.
At last, left prerenal fascia will be resected.
When the tumor abuts or infiltrates the left adrenal gland, left adrenalectomy will be performed, which is also called "posterior approach RAMPS".
While in normal cases, left adrenal gland will be preserved.
|
Radical antegrade modular pancreatosplenectomy (RAMPS) includes the following aspects.
Firstly, the surgical approach is "antegrade", which means from the right to the left, the pancreatic neck will be transected at first and the spleen will be seperated at last.
Secondly, lymph nodes dissection includes not only the regional lymph nodes(No.10,11,18
lymph nodes), but also N1 station lymph nodes (N1: 6, 8a, 8p, 12a2/b2/p2, 13a/b, 14b/c/d, 14v, 17a/b), No.7, 9 lymph nodes, the lymph nodes anterior and left of superior mesenteric artery, as well as the peripheral nerve of celiac trunk.
Thirdly, the transection platform is in the pancreatic neck, which is mandatory.
At last, left prerenal fascia will be resected.
When the tumor abuts or infiltrates the left adrenal gland, left adrenalectomy will be performed, which is also called "posterior approach RAMPS".
While in normal cases, left adrenal gland will be preserved.
|
Active Comparator: SRPS group
Standard retrograde pancreatosplenectomy(SRPS) includes several key points.
Firstly, the surgical approach is "retrograde", which means from the left to the right, spleen will be seperated at first and the pancreas will be transected later on.
Secondly, only the regional lymph nodes will be dissected, which include No.10, No.11, No.18 lymph nodes, and No.9 lymph nodes should be dissected only when the lesion is in pancreatic neck.
Thirdly, the transection platform is in the left side of the lesion, but transection at pancreatic neck is not mandatory.
At last, the surgical plane is anterior to the left renal fascia, prerenal fascia will be preserved.
|
Standard retrograde pancreatosplenectomy(SRPS) includes several aspects.
Firstly, the surgical approach is "retrograde", which means from the left to the right, spleen will be seperated at first and the pancreas will be transected later on.
Secondly, only the regional lymph nodes will be dissected, which include No.10, No.11, No.18 lymph nodes, and No.9 lymph nodes should be dissected only when the lesion is in pancreatic neck.
Thirdly, the transection platform is in the left side of the lesion, but transection at pancreatic neck is not mandatory.
At last, the surgical plane is anterior to the left renal fascia, prerenal fascia will be preserved.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival
Time Frame: 21 months
|
Overall survival was defined as the time from surgery to either death or last follow-up.
Patients will be observed or contacted every 2 months in the first 2 years after surgery and then every 3 months thereafter.
Overall survival measurement will be based on patient's survival status and what is the date of death if the patient is not alive.
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21 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Disease free survival
Time Frame: 11 months
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DFS was calculated from the date of surgery to the date of recurrence or last follow-up if recurrence did not occur.
Recurrence was diagnosed by imaging examination like CT, MRI, PET-CT and PET-MRI.
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11 months
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R0 resection rate
Time Frame: 1 month
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R0 resection was defined as absence of malignant cells within 1 mm from the resection margin using the Royal College of Pathologists definition.
The assessment of the margin status will be done by pathologists.
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1 month
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retrieved lymph nodes
Time Frame: 1 month
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The dissected lymph nodes will be sent to pathology department and the pathologists will separate the lymph nodes and give reports about how many lymph nodes are found and if the lymph nodes are positive or negative.
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1 month
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
operation time in minutes
Time Frame: 1 day
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Operation time means "skin to skin"time (from the surgeon start to incise the skin to the last suture of the skin)
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1 day
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estimated blood loss in milliliters
Time Frame: 1 day
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Estimated blood loss will be evaluated based on the vacuum amount, gauze weight and liquid intake
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1 day
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postoperative pancreatic fistula in percentage
Time Frame: 3 months
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According to the definition of International Study Group on Pancreatic Fistula(ISGPF)
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3 months
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postpancreatectomy hemorrhage in percentage
Time Frame: 3 months
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Postpancreatectomy hemorrhage is defined by International Study Group on Pancreatic Surgery
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3 months
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delayed gastric emptying in percentage
Time Frame: 3 months
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Delayed gastric emptying is defined by International Study Group on Pancreatic Surgery
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3 months
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Surgical site infection in percentage
Time Frame: 3 months
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Surgical site infections are defined by the Center for Disease Control and Prevention (CDC) definition, and diagnosed by positive pathogen culture in 2 weeks from surgery
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3 months
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30-day mortality in percentage
Time Frame: 1 month
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Any death within 30 days in postoperative period will be calculated
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1 month
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90-day mortality in percentage
Time Frame: 3 months
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Any death within 90 days in postoperative period will be calculated
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3 months
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Anticipated)
February 15, 2020
Primary Completion (Anticipated)
February 28, 2022
Study Completion (Anticipated)
February 28, 2027
Study Registration Dates
First Submitted
January 29, 2020
First Submitted That Met QC Criteria
February 1, 2020
First Posted (Actual)
February 5, 2020
Study Record Updates
Last Update Posted (Actual)
February 5, 2020
Last Update Submitted That Met QC Criteria
February 1, 2020
Last Verified
January 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HBP-RCT-005
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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