ArticleTrials2023
Conventional partial pancreatoduodenectomy versus an extended pancreatoduodenectomy (triangle operation) for pancreatic head cancers-study protocol for the randomised controlled TRIANGLE trial.
Article in Trials, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 9 citations in OpenAlex.
- Pancreatic Cancer Frequently Infiltrates the TRIANGLE Compartment: A Surgical Option to Prevent Local Recurrence.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- New implications from long-term outcomes of perioperative therapy in resectable pancreatic cancer.British journal of cancer · 2026Review
- Recent advances in operative techniques for pancreatic surgery.Innovative surgical sciences · 2025Review
- Lymphatic metastasis in pancreatic cancer: from bedside to bench and back.Cancer metastasis reviews · 2025Review
- Conventional partial pancreatoduodenectomy versus an uncinate first, extended partial pancreatoduodenectomy approach for the resection of pancreatic head cancer: the randomized, controlled PancER trial.Innovative surgical sciences · 2025Article
- [Evidence for the extent and oncological benefit of lymphadenectomy for pancreatic cancer].Chirurgie (Heidelberg, Germany) · 2025Review
- Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study.JNMA; journal of the Nepal Medical Association · 2025Observational
- Survival after vascular resections in patients with borderline resectable or locally advanced pancreatic head cancer: A systematic review.Annals of hepato-biliary-pancreatic surgery · 2024Review
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundPancreatic ductal carcinoma (PDAC) is the fourth most frequent cause of cancer-related death in the Western world, and its incidence is rising. In patients that undergo curative resection, local recurrence (LR) is frequent. A recently described surgical technique of extended pancreatoduodenectomy (PD) termed the TRIANGLE operation has been proposed as a promising approach to reduce LR and improve disease-free survival in PDAC patients.
methodsThe TRIANGLE trial is a multicentre confirmatory randomised controlled superiority trial with two parallel study groups. A total of 270 patients with suspected or histologically confirmed pancreatic head cancer scheduled for PD will be included in the trial and randomly assigned to the intervention group (extended PD defined as Inoue level 3 dissection along the superior mesenteric and celiac artery as well as removal of all soft tissue in the so-called triangle between the celiac artery, the SMA and the mesenterico-portal axis) or the control group (conventional PD with lymphadenectomy and removal of soft tissue according to current guidelines). The primary endpoint of the trial will be the disease-free survival of patients. Other perioperative outcomes as well as oncological parameters and patient-reported outcomes will be analysed as secondary outcomes. DISCUSSION: Despite multimodal treatment, LR remains high and disease-free survival is limited following PD for PDAC. The TRIANGLE operation could address these shortcomings of conventional PD as indicated in several retrospective studies. However, this technique could be associated with more adverse events for patients including intractable diarrhoea. The TRIANGLE trial will close the evidence gap as well as offer a risk-benefit assessment of this more radical approach to PD.
trial registrationGerman Clinical Trials Register DRKS00030576 (UTN U1111-1243-4412) 19th December 2022.
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