Evidence map›Paper›PMID 40772617›Full record

Trial reportAnnals of surgery2026

Mesenteric Versus Conventional Approach During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma (MAPLE-PD trial): A Multicenter Randomized Controlled Trial.

Seiko Hirono, Yuji Kitahata, Hideki Motobayashi, Sohei Satoi, Masayuki Sho, Hideki Takami, Keiko Kamei, Kazuto Shibuya, Masaaki Hidaka, Kenichiro Uemura and 11 more

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03317886 (Mesenteric Approach vs. Conventional Approach for Pancreatic Cancer During Pancreaticoduodenectomy), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03317886 phase3unknown statusnot on this map

Mesenteric Approach vs. Conventional Approach for Pancreatic Cancer During Pancreaticoduodenectomy (MAPLE-PD Trial)

TypeinterventionalSponsorWakayama Medical UniversityRan2017 to 2021Enrolled354ConditionsPancreatic Ductal Adenocarcinoma, Pancreaticoduodenectomy, Mesenteric ApproachArmspancreaticoduodenectomy
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Seiko HironoSecond Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.ORCID 0000-0003-3054-1038
Yuji KitahataSecond Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Hideki MotobayashiSecond Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Sohei SatoiDepartment of Pancreatobiliary Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
Masayuki ShoDepartment of Surgery, Nara Medical University, Kashihara, Nara, Japan.
Hideki TakamiDepartment of Gastroenterological Surgery, Nagoya University, Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
Keiko KameiDepartment of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
Kazuto ShibuyaDepartment of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan.
Masaaki HidakaDepartment of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Kenichiro UemuraDepartment of Surgery, Institute of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan.
Kenjiro KimuraDepartment of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Abeno-ku, Osaka, Japan.
Yuko MatakiDepartment of Digestive surgery, Kagoshima University, Kagoshima city, Kagoshima, Japan.
Yuichi NagakawaDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
Hiromitsu HayashiDepartment of Gastroenterology, Kumamoto University, Honjo, Kumamoto, Japan.
Ryo MorimuraDepartment of Digestive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Masafumi NakamuraDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
Ke WanSchool of Medicine, Wakayama Medical University, Clinical Study Support Center, Wakayama, Japan.
Toshio ShimokawaSchool of Medicine, Wakayama Medical University, Clinical Study Support Center, Wakayama, Japan.
Akimasa NakaoDepartment of Gastroenterological Surgery, Nagoya Central Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
Hiroki YamaueSecond Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
MAPLE-PD trial investigators

Funding

Japan Surgical Society Clinical Investigation Project Award.
6 · The paper itself

Abstract

objectiveThis multicenter randomized controlled trial investigated whether the mesenteric approach, which is an infracolic superior mesenteric artery (SMA)-first approach during pancreatoduodenectomy (PD), can improve survival in patients with pancreatic ductal adenocarcinoma (PDAC), compared with the Kocher-first conventional approach.

backgroundThe mesenteric approach might improve surgical outcomes through a nontouch isolation technique for PDAC.

methodsThis trial was conducted in 24 Japanese high-volume centers. Patients who were scheduled to undergo PD for resectable PDAC or borderline resectable PDAC with portal vein invasion (BR-PV PDAC) were randomly assigned (1:1) via a central web-based application to the conventional or mesenteric approach. The primary endpoint was overall survival (OS). We also analyzed circulating tumor cell (CTC) DNA in the PV blood obtained during surgery. This trial is registered with ClinicalTrials.gov. NCT03317886, and UMIN Clinical Trials UMIN000029615.

resultsBetween 2018 and 2021, 360 patients were randomly assigned to conventional (n=181) and mesenteric groups (n=179). With a median follow-up of 39.3 months, the median OS was comparable between conventional and mesenteric groups (41.7 vs. 39.3 months; HR 1.02, 95% CI: 0.76-1.37, P =0.897). CTC analysis showed that the mean change in CTC DNA copy number in PV obtained at laparotomy and just before removal of the specimen was significantly different between the conventional (10.1±2.7) and mesenteric (-7.3±2.6) groups ( P <0.001).

conclusionsThe mesenteric approach does not improve survival in patients with resectable or BR-PV PDAC, although it might prevent spread of cancer cells via vessels during surgery through the nontouch isolation procedure.

Indexed as

Carcinoma, Pancreatic DuctalPancreatic NeoplasmsPancreaticoduodenectomyAgedFemaleHumansMaleMesenteric Artery, SuperiorMiddle AgedSurvival RateTreatment Outcomeartery-first approachconventional approachmesenteric approachpancreatic ductal adenocarcinomapancreatoduodenectomysuperior mesenteric artery

Identifiers

PMID40772617
PMCPMC12978713

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.