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Vissers FL, Balduzzi A, van Bodegraven EA, van Hilst J, Festen S, Hilal MA, Asbun HJ, Mieog JSD, Koerkamp BG, Busch OR, Daams F, Luyer M, De Pastena M, Malleo G, Marchegiani G, Klaase J, Molenaar IQ, Salvia R, van Santvoort HC, Stommel M, Lips D, Coolsen M, Bassi C, van Eijck C, Besselink MG. Correction: Prophylactic abdominal drainage or no drainage after distal pancreatectomy (PANDORINA): a study protocol of a binational multicenter randomized controlled trial. Trials 2023; 24:121. [PMID: 36803266 PMCID: PMC9940380 DOI: 10.1186/s13063-022-06957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- F. L. Vissers
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - A. Balduzzi
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - E. A. van Bodegraven
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - J. van Hilst
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.440209.b0000 0004 0501 8269Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - S. Festen
- grid.440209.b0000 0004 0501 8269Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - M. Abu Hilal
- grid.430506.40000 0004 0465 4079Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK ,grid.415090.90000 0004 1763 5424Department of Surgery, Poliambulanza Hospital Brescia, Brescia, Italy
| | - H. J. Asbun
- grid.418212.c0000 0004 0465 0852Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, USA
| | - J. S. D. Mieog
- grid.10419.3d0000000089452978Department of Surgery, LUMC, Leiden, the Netherlands
| | - B. Groot Koerkamp
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - O. R. Busch
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - F. Daams
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - M. Luyer
- grid.413532.20000 0004 0398 8384Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M. De Pastena
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G. Malleo
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G. Marchegiani
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - J. Klaase
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - I. Q. Molenaar
- grid.7692.a0000000090126352Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R. Salvia
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - H. C. van Santvoort
- grid.415960.f0000 0004 0622 1269Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein, Utrecht, the Netherlands
| | - M. Stommel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud UMC, Nijmegen, the Netherlands
| | - D. Lips
- grid.415214.70000 0004 0399 8347Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M. Coolsen
- grid.412966.e0000 0004 0480 1382Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - C. Bassi
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - C. van Eijck
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - M. G. Besselink
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
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Vissers FL, Balduzzi A, van Bodegraven EA, van Hilst J, Festen S, Hilal MA, Asbun HJ, Mieog JSD, Koerkamp BG, Busch OR, Daams F, Luyer M, De Pastena M, Malleo G, Marchegiani G, Klaase J, Molenaar IQ, Salvia R, van Santvoort HC, Stommel M, Lips D, Coolsen M, Bassi C, van Eijck C, Besselink MG. Prophylactic abdominal drainage or no drainage after distal pancreatectomy (PANDORINA): a binational multicenter randomized controlled trial. Trials 2022; 23:809. [PMID: 36153559 PMCID: PMC9509576 DOI: 10.1186/s13063-022-06736-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prophylactic abdominal drainage is current standard practice after distal pancreatectomy (DP), with the aim to divert pancreatic fluid in case of a postoperative pancreatic fistula (POPF) aimed to prevent further complications as bleeding. Whereas POPF after pancreatoduodenectomy, by definition, involves infection due to anastomotic dehiscence, a POPF after DP is essentially sterile since the bowel is not opened and no anastomoses are created. Routine drainage after DP could potentially be omitted and this could even be beneficial because of the hypothetical prevention of drain-induced infections (Fisher, Surgery 52:205-22, 2018). Abdominal drainage, moreover, should only be performed if it provides additional safety or comfort to the patient. In clinical practice, drains cause clear discomfort. One multicenter randomized controlled trial confirmed the safety of omitting abdominal drainage but did not stratify patients according to their risk of POPF and did not describe a standardized strategy for pancreatic transection. Therefore, a large pragmatic multicenter randomized controlled trial is required, with prespecified POPF risk groups and a homogeneous method of stump closure. The objective of the PANDORINA trial is to evaluate the non-inferiority of omitting routine intra-abdominal drainage after DP on postoperative morbidity (Clavien-Dindo score ≥ 3), and, secondarily, POPF grade B/C. METHODS/DESIGN Binational multicenter randomized controlled non-inferiority trial, stratifying patients to high and low risk for POPF grade B/C and incorporating a standardized strategy for pancreatic transection. Two groups of 141 patients (282 in total) undergoing elective DP (either open or minimally invasive, with or without splenectomy). Primary outcome is postoperative rate of morbidity (Clavien-Dindo score ≥ 3), and the most relevant secondary outcome is grade B/C POPF. Other secondary outcomes include surgical reintervention, percutaneous catheter drainage, endoscopic catheter drainage, abdominal collections (not requiring drainage), wound infection, delayed gastric emptying, postpancreatectomy hemorrhage as defined by the international study group for pancreatic surgery (ISGPS) (Wente et al., Surgery 142:20-5, 2007), length of stay (LOS), readmission within 90 days, in-hospital mortality, and 90-day mortality. DISCUSSION PANDORINA is the first binational, multicenter, randomized controlled non-inferiority trial with the primary objective to evaluate the hypothesis that omitting prophylactic abdominal drainage after DP does not worsen the risk of postoperative severe complications (Wente etal., Surgery 142:20-5, 2007; Bassi et al., Surgery 161:584-91, 2017). Most of the published studies on drain placement after pancreatectomy focus on both pancreatoduodenectomy and DP, but these two entities present are associated with different complications and therefore deserve separate evaluation (McMillan et al., Surgery 159:1013-22, 2016; Pratt et al., J Gastrointest Surg 10:1264-78, 2006). The PANDORINA trial is innovative since it takes the preoperative risk on POPF into account based on the D-FRS and it warrants homogenous stump closing by using the same graded compression technique and same stapling device (de Pastena et al., Ann Surg 2022; Asbun and Stauffer, Surg Endosc 25:2643-9, 2011).
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Affiliation(s)
- F. L. Vissers
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - A. Balduzzi
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - E. A. van Bodegraven
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - J. van Hilst
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.440209.b0000 0004 0501 8269Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - S. Festen
- grid.440209.b0000 0004 0501 8269Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - M. Abu Hilal
- grid.430506.40000 0004 0465 4079Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK ,grid.415090.90000 0004 1763 5424Department of Surgery, Poliambulanza Hospital Brescia, Brescia, Italy
| | - H. J. Asbun
- grid.418212.c0000 0004 0465 0852Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, USA
| | - J. S. D. Mieog
- grid.10419.3d0000000089452978Department of Surgery, LUMC, Leiden, the Netherlands
| | - B. Groot Koerkamp
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - O. R. Busch
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - F. Daams
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - M. Luyer
- grid.413532.20000 0004 0398 8384Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M. De Pastena
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G. Malleo
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G. Marchegiani
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - J. Klaase
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - I. Q. Molenaar
- grid.7692.a0000000090126352Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R. Salvia
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - H. C. van Santvoort
- grid.415960.f0000 0004 0622 1269Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein, Utrecht, the Netherlands
| | - M. Stommel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud UMC, Nijmegen, the Netherlands
| | - D. Lips
- grid.415214.70000 0004 0399 8347Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M. Coolsen
- grid.412966.e0000 0004 0480 1382Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - C. Bassi
- grid.411475.20000 0004 1756 948XDepartment of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - C. van Eijck
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - M. G. Besselink
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
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