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Trials
Published in: Trials 1/2018

Open Access 01-12-2018 | Study protocol

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Authors: Thijs de Rooij, Jony van Hilst, Koop Bosscha, Marcel G. Dijkgraaf, Michael F. Gerhards, Bas Groot Koerkamp, Jeroen Hagendoorn, Ignace H. de Hingh, Tom M. Karsten, Daan J. Lips, Misha D. Luyer, I. Quintus Molenaar, Hjalmar C. van Santvoort, T. C. Khé Tran, Olivier R. Busch, Sebastiaan Festen, Marc G. Besselink, for the Dutch Pancreatic Cancer Group

Published in: Trials | Issue 1/2018

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Abstract

Background

Data from observational studies suggest that minimally invasive pancreatoduodenectomy (MIPD) is superior to open pancreatoduodenectomy regarding intraoperative blood loss, postoperative morbidity, and length of hospital stay, without increasing total costs. However, several case-matched studies failed to demonstrate superiority of MIPD, and large registry studies from the USA even suggested increased mortality for MIPDs performed in low-volume (<10 MIPDs annually) centers. Randomized controlled multicenter trials are lacking but clearly required. We hypothesize that time to functional recovery is shorter after MIPD compared with open pancreatoduodenectomy, even in an enhanced recovery setting.

Methods/design

LEOPARD-2 is a randomized controlled, parallel-group, patient-blinded, multicenter, phase 2/3, superiority trial in centers that completed the Dutch Pancreatic Cancer Group LAELAPS-2 training program for laparoscopic pancreatoduodenectomy or LAELAPS-3 training program for robot-assisted pancreatoduodenectomy and have performed ≥ 20 MIPDs. A total of 136 patients with symptomatic benign, premalignant, or malignant disease will be randomly assigned to undergo minimally invasive or open pancreatoduodenectomy in an enhanced recovery setting. After the first 40 patients (phase 2), the data safety monitoring board will assess safety outcomes (not blinded for treatment allocation) and decide on continuation to phase 3. Patients from phase 2 will then be included in phase 3. The primary outcome measure is time (days) to functional recovery. All patients will be blinded for the surgical approach, at least until postoperative day 5, but preferably until functional recovery has been attained. Secondary outcome measures are operative and postoperative outcomes, including clinically relevant complications, mortality, quality of life, and costs.

Discussion

The LEOPARD-2 trial is designed to assess whether MIPD reduces time to functional recovery, as compared with open pancreatoduodenectomy in an enhanced recovery setting.

Trial registration

Netherlands Trial Register, NTR5689. Registered on 2 March 2016.
Appendix
Available only for authorised users
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Metadata
Title
Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial
Authors
Thijs de Rooij
Jony van Hilst
Koop Bosscha
Marcel G. Dijkgraaf
Michael F. Gerhards
Bas Groot Koerkamp
Jeroen Hagendoorn
Ignace H. de Hingh
Tom M. Karsten
Daan J. Lips
Misha D. Luyer
I. Quintus Molenaar
Hjalmar C. van Santvoort
T. C. Khé Tran
Olivier R. Busch
Sebastiaan Festen
Marc G. Besselink
for the Dutch Pancreatic Cancer Group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2423-4

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