Isolation Procedure vs. Conventional Procedure During Distal Pancreatectosplenectomy for Pancreatic Cancer

Randomized Controlled Phase II Study of Isolation Procedure Versus Conventional Procedure in Distal Pancreatosplenectomy for Pancreatic Cancer

In the distal pancreatectomy (including pancreatic tail resection) for invasive ductal carcinoma of the pancreas, we evaluate the usefulness of a procedure of firstly transection of splenic arteries and veins (the isolation procedure group) compared to a conventional procedure of transection of the splenic vein at the end.

Inclusion Criteria:

• Resectable pancreatic cancer (Adenocarcinoma, adenosquamous cell carcinoma, mucinous carcinoma, and anaplastic carcinoma according to the 7th edition of the regulations for handling pancreatic cancer)
• ASA-PS (American Society of Anesthesiology, General condition classification) is Class 1-3.
• Age are over 20 years old.
• Able to understand the content of the research and has obtained written consent from the person himself/herself.

Exclusion Criteria:

• Non-resectable pancreatic cancer by image diagnosis at the initial diagnosis
• Cases suspected of portal vein (superior mesenteric vein) invasion
• Patients with severe ischemic heart disease
• Patients with cirrhosis or active hepatitis requiring treatment
• Patients with dyspnea requiring oxygen administration
• Patients undergoing dialysis due to chronic renal failure
• Cases in which arterial reconstruction of the superior mesenteric artery, common hepatic artery, celiac artery, etc. is considered necessary
• Patients with strong suspected paraaortic lymph node metastasis
• Active double cancer thought to affect adverse events and prognosis
• Long-term oral steroids that may affect adverse events
• Patients who are considered to have difficulty participating in the study due to psychosis or psychiatric symptoms.
• Cases other than invasive pancreatic ductal carcinoma by preoperative biopsy. Invasive intraductal papillary mucinous carcinoma (IPMC) is excluded.
• Patients who cannot use both iodine drugs and gadnium drugs due to severe drug allergy
• Cases where the prescribed procedure is difficult due to history of upper abdominal surgery such as stomach, spleen, kidney, liver, transverse colon, retroperitoneum including pancreas and pancreatitis