Protocol of a prospective study investigating the association of PAncreatic parenchymal RISk factors with postoperative pancreatic fistula after partial pancreaticoduodenectomy (PARIS trial)

INTRODUCTION

Partial pancreatoduodenectomy (PD) is the treatment of choice for many malignant and benign diseases of the pancreatic head. Postoperative complication rates of up to 40% are regularly reported. One of the most common and potentially life-threatening complication is the postoperative pancreatic fistula (POPF). Parenchymal risk factors like main pancreatic duct diameter or texture of the pancreatic gland have already been identified in retrospective studies. The aim of this study is to evaluate the diagnostic value of parenchymal risk factors on POPF in a prospective manner.

METHODS AND ANALYSIS

All patients scheduled for elective PD at the Department of General, Visceral and Transplantation Surgery of the University of Heidelberg will be screened for eligibility. As diagnostic factors, diameter and texture of the pancreatic gland as well as radiological and histopathological features will be recorded. Furthermore, the new four class risk classification system by the International Study Group of Pancreatic Surgery (ISGPS) will be recorded. The postoperative course will be monitored prospectively. The primary endpoint will be the association of the main pancreatic duct size and the texture of the pancreatic gland on POPF according to the updated ISGPS definition. The diagnostic value of the above-mentioned factors for POPF will be evaluated in a univariable and multivariable analysis.

ETHICS AND DISSEMINATION

PARIS is a monocentric, prospective, diagnostic study to evaluate the association of parenchymal risk factors and the development of POPF approved by the Ethics Committee of the medical faculty of Heidelberg University (S-344/2019). Results will be available in 2022 and will be published at national and international meetings. With this knowledge, the intraoperative and perioperative decision-making process could be eased and improve the individual outcome of patient.

TRIAL REGISTRATION NUMBER

DRKS00017184.

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

INTRODUCTION

In recent years, minimally invasive distal pancreatectomy (MIDP) has been used with increasing frequency to accelerate patient recovery. Distal pancreatectomy has an overall morbidity rate of 30%-40%. The known advantages of minimally invasive techniques must be rigorously compared with those of open surgery before they can be completely implemented into clinical practice.

METHODS AND ANALYSIS

DISPACT-2 is a multicentre randomised controlled trial comparing minimally invasive (conventional laparoscopic or robotic assisted) with open distal pancreatic resection in patients undergoing elective surgery for benign as well as malign diseases of the pancreatic body and tail. After screening for eligibility and obtaining informed consent, a total of 294 adult patients will be preoperatively randomised in a 1:1 ratio. The primary hypothesis is that MIDP is non-inferior to open distal pancreatectomy in terms of postoperative mortality and morbidity expressed as the Comprehensive Complication Index (CCI) within 3 months after index operation, with a non-inferiority margin of 7.5 CCI points. Secondary endpoints include pancreas-specific complications, oncological safety and patient reported outcomes. Follow-up for each individual patient will be 2 years.

ETHICS AND DISSEMINATION

The DISPACT-2 trial has been approved by the Ethics Committee of the medical faculty of Heidelberg University (S-693/2017). Results of the primary endpoint will be available in 2024 and will be published at national and international meetings. Full results will be made available in an open access, peer-reviewed journal. The website www.dispact.de contains up-to-date information regarding the trial.

TRIAL REGISTRATION NUMBER

DRKS00014011.

[Acceptance of preventive vaccinations by physicians and the general population]

The acceptance of vaccinations depends on the quality of information on effects and side effects. This publication deals with the results of three questionnaire studies: Questionnaire 1 was directed to the general population and contained questions on vaccination history and acceptance of vaccinations, questionnaire two and three were addressed to practitioners (general medicine/paediatrics/internal medicine) with additional questions on the number of vaccinations performed per year. An average of 50% of the persons taking part in the questionnaire study had been vaccinated within the last 10 years against diphtheria, tetanus, polio and/or influenza. The acceptance of these vaccinations was quite satisfactory whereas opinions on mumps and measles vaccinations were quite negative. In the course of the questionnaire study with practitioners it could be demonstrated that vaccinations against diphtheria, tetanus, polio and influenza were regarded as useful while immunisation against mumps, measles, tuberculosis, pertussis and chicken-pox were not regarded as useful. Information programes on vaccinations and the need for further investigations are discussed as well as the problem of mandatory vaccinations.