A trial looking at two different ways of joining the pancreas to the bowel during surgery for pancreatic cancer (PANasta)

Cancer type:

Pancreatic cancer

Status:

Results

Phase:

Phase 3

This trial compared two ways of joining what remains of the pancreas to the bowel during surgery for pancreatic cancer.

Cancer Research UK supported this trial.

This trial was open for people to join between 2015 and 2017. The team published the results in 2022.

More about this trial

Surgery is a usual treatment to remove pancreatic cancer that hasn’t spread. One of the main types of surgery for pancreatic cancer is a Whipple's operation.

A Whipple’s procedure involves removing:

part of your pancreas
the first part of your small bowel (the duodenum)
your gallbladder
part of your bile duct and
sometimes part of your stomach

Once the surgery is done, the surgeon joins the remaining part of the pancreas to the small bowel. Connecting two different parts of the body during surgery is called an anastomosis Open a glossary item .

A possible complication of this surgery is leakage from the anastomosis. This is not normally serious, but it can mean a longer stay in hospital. It might also delay any further treatment for pancreatic cancer.

Doctors did this trial to compare the two standard methods of creating the anastomosis. These were the methods used when this trial was carried out.

The main aims of the trial were to find out:

which method of anastomosis is better at reducing the risk of surgical problems such as leakage or infection
how long people live after surgery
how long people stay in hospital after surgery

Summary of results

Trial design
This trial was for people who were due to have a type of surgery called a Whipple's operation for suspected pancreatic cancer.

The people taking part had one of the following standard methods of joining the pancreas and small bowel:

Cattell-Warren method
The pancreas and small bowel are joined together around the outside by stitches.

Blumgart method
The pancreas and the small bowel are secured by stitches. These roll the edges of the small bowel outwards around the pancreas.

A computer put people into a treatment group at random:

113 people had the Cattell-Warren method
125 people had the Blumgart method

Results
The team had the results for 236 people. They followed everyone for up to 12 months after surgery. They looked at:

complications people developed such as leakage or infections
who needed more cancer treatment after surgery
how long people lived
serious side effects

They didn’t find much of a difference in any of these between the 2 different groups.

Side effects
Most people taking part had at least 1 side effect. Some were mild or didn’t last long.

About 1 in 10 people developed a pancreatic leak. A similar number of people in each group had this problem. People with a leak often developed other complications.

Conclusion
The trial team concluded that they were able to thoroughly compare the 2 methods of anastomosis. They looked at different areas including the side effects of surgery. And they found that there wasn’t much of a difference between the 2 groups.

More detailed information
There is more information about this research in the reference below.

Please note, this article is not in plain English. It has been written for health care professionals and researchers.

A Multicenter, Randomized, Double-Blinded, Clinical Trial Comparing Cattell-Warren and Blumgart Anastomoses Following Partial Pancreatoduodenectomy
C Halloran and others
Annals of Surgery, 2022, 3(3):e198

Where this information comes from
We have based this summary on the information in the article above. This has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the link we list above are active and the article is free and available to view.