Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

E M Wong-Lun-Hing; R M van Dam; G J P van Breukelen; P J Tanis; F Ratti; R van Hillegersberg; G D Slooter; J H W de Wilt; M S L Liem; M T de Boer; J M Klaase; U. P. Neumann; L A Aldrighetti; C H C Dejong; ORANGE II Collaborative Group

doi:10.1002/bjs.10438

Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

E M Wong-Lun-Hing, R M van Dam^*, G J P van Breukelen, P J Tanis, F Ratti, R van Hillegersberg, G D Slooter, J H W de Wilt, M S L Liem, M T de Boer, J M Klaase, U. P. Neumann, L A Aldrighetti, C H C Dejong, ORANGE II Collaborative Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BackgroundLaparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided.

MethodsIn this multicentre double-blind RCT, patients (aged 18-80years with a BMI of 18-35kg/m(2) and ASA fitness grade of III or below) requiring left lateral sectionectomy (LLS) were assigned randomly to OLLS or LLLS within an enhanced recovery after surgery (ERAS) programme. All randomized patients, ward physicians and nurses were blinded to the procedure undertaken. A parallel prospective registry (open non-randomized (ONR) versus laparoscopic non-randomized (LNR)) was used to monitor patients who were not enrolled for randomization because of doctor or patient preference. The primary endpoint was time to functional recovery. Secondary endpoints were length of hospital stay (LOS), readmission rate, overall morbidity, composite endpoint of liver surgery-specific morbidity, mortality, and reasons for delay in discharge after functional recovery.

ResultsBetween January 2010 and July 2014, patients were recruited at ten centres. Of these, 24 patients were randomized at eight centres, and 67 patients from eight centres were included in the prospective registry. Owing to slow accrual, the trial was stopped on the advice of an independent Data and Safety Monitoring Board in the Netherlands. No significant difference in median (i.q.r.) time to functional recovery was observed between laparoscopic and open surgery in the randomized or non-randomized groups: 3 (3-5) days for OLLSversus 3 (3-3) days for LLLS; and 3 (3-3) days for ONRversus 3 (3-4) days for LNR. There were no significant differences with regard to LOS, morbidity, reoperation, readmission and mortality rates.

ConclusionThis RCT comparing open and laparoscopic LLS in an ERAS setting was not able to reach a conclusion on time to functional recovery, because it was stopped prematurely owing to slow accrual. Registration number: NCT00874224 ( ).

A lesson in trial design

Original language	English
Pages (from-to)	525–535
Number of pages	11
Journal	British Journal of Surgery
Volume	104
Issue number	5
Early online date	31 Jan 2017
DOIs	https://doi.org/10.1002/bjs.10438
Publication status	Published - Apr 2017

Keywords

NUMERIC RATING-SCALE
FAST-TRACK PROGRAM
LIVER SURGERY
RESECTION
PROTOCOL
OUTCOMES
CANCER

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10.1002/bjs.10438

Cite this

Wong-Lun-Hing, E. M., van Dam, R. M., van Breukelen, G. J. P., Tanis, P. J., Ratti, F., van Hillegersberg, R., Slooter, G. D., de Wilt, J. H. W., Liem, M. S. L., de Boer, M. T., Klaase, J. M., Neumann, U. P., Aldrighetti, L. A., Dejong, C. H. C., & ORANGE II Collaborative Group (2017). Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). British Journal of Surgery, 104(5), 525–535. https://doi.org/10.1002/bjs.10438

@article{8416525de2d7435eac5e881ab54a2b9e,

title = "Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)",

abstract = "BackgroundLaparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided.MethodsIn this multicentre double-blind RCT, patients (aged 18-80years with a BMI of 18-35kg/m(2) and ASA fitness grade of III or below) requiring left lateral sectionectomy (LLS) were assigned randomly to OLLS or LLLS within an enhanced recovery after surgery (ERAS) programme. All randomized patients, ward physicians and nurses were blinded to the procedure undertaken. A parallel prospective registry (open non-randomized (ONR) versus laparoscopic non-randomized (LNR)) was used to monitor patients who were not enrolled for randomization because of doctor or patient preference. The primary endpoint was time to functional recovery. Secondary endpoints were length of hospital stay (LOS), readmission rate, overall morbidity, composite endpoint of liver surgery-specific morbidity, mortality, and reasons for delay in discharge after functional recovery.ResultsBetween January 2010 and July 2014, patients were recruited at ten centres. Of these, 24 patients were randomized at eight centres, and 67 patients from eight centres were included in the prospective registry. Owing to slow accrual, the trial was stopped on the advice of an independent Data and Safety Monitoring Board in the Netherlands. No significant difference in median (i.q.r.) time to functional recovery was observed between laparoscopic and open surgery in the randomized or non-randomized groups: 3 (3-5) days for OLLSversus 3 (3-3) days for LLLS; and 3 (3-3) days for ONRversus 3 (3-4) days for LNR. There were no significant differences with regard to LOS, morbidity, reoperation, readmission and mortality rates.ConclusionThis RCT comparing open and laparoscopic LLS in an ERAS setting was not able to reach a conclusion on time to functional recovery, because it was stopped prematurely owing to slow accrual. Registration number: NCT00874224 ( ).A lesson in trial design",

keywords = "NUMERIC RATING-SCALE, FAST-TRACK PROGRAM, LIVER SURGERY, RESECTION, PROTOCOL, OUTCOMES, CANCER",

author = "Wong-Lun-Hing, {E M} and {van Dam}, {R M} and {van Breukelen}, {G J P} and Tanis, {P J} and F Ratti and {van Hillegersberg}, R and Slooter, {G D} and {de Wilt}, {J H W} and Liem, {M S L} and {de Boer}, {M T} and Klaase, {J M} and Neumann, {U. P.} and Aldrighetti, {L A} and Dejong, {C H C} and {ORANGE II Collaborative Group}",

note = "{\textcopyright} 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.",

year = "2017",

month = apr,

doi = "10.1002/bjs.10438",

language = "English",

volume = "104",

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journal = "British Journal of Surgery",

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Wong-Lun-Hing, EM, van Dam, RM , van Breukelen, GJP, Tanis, PJ, Ratti, F, van Hillegersberg, R, Slooter, GD, de Wilt, JHW, Liem, MSL, de Boer, MT, Klaase, JM, Neumann, UP, Aldrighetti, LA, Dejong, CHC & ORANGE II Collaborative Group 2017, 'Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)', British Journal of Surgery, vol. 104, no. 5, pp. 525–535. https://doi.org/10.1002/bjs.10438

Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). / Wong-Lun-Hing, E M; van Dam, R M ; van Breukelen, G J P et al.
In: British Journal of Surgery, Vol. 104, No. 5, 04.2017, p. 525–535.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

AU - Wong-Lun-Hing, E M

AU - van Dam, R M

AU - van Breukelen, G J P

AU - Tanis, P J

AU - Ratti, F

AU - van Hillegersberg, R

AU - Slooter, G D

AU - de Wilt, J H W

AU - Liem, M S L

AU - de Boer, M T

AU - Klaase, J M

AU - Neumann, U. P.

AU - Aldrighetti, L A

AU - Dejong, C H C

AU - ORANGE II Collaborative Group

PY - 2017/4

Y1 - 2017/4

N2 - BackgroundLaparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided.MethodsIn this multicentre double-blind RCT, patients (aged 18-80years with a BMI of 18-35kg/m(2) and ASA fitness grade of III or below) requiring left lateral sectionectomy (LLS) were assigned randomly to OLLS or LLLS within an enhanced recovery after surgery (ERAS) programme. All randomized patients, ward physicians and nurses were blinded to the procedure undertaken. A parallel prospective registry (open non-randomized (ONR) versus laparoscopic non-randomized (LNR)) was used to monitor patients who were not enrolled for randomization because of doctor or patient preference. The primary endpoint was time to functional recovery. Secondary endpoints were length of hospital stay (LOS), readmission rate, overall morbidity, composite endpoint of liver surgery-specific morbidity, mortality, and reasons for delay in discharge after functional recovery.ResultsBetween January 2010 and July 2014, patients were recruited at ten centres. Of these, 24 patients were randomized at eight centres, and 67 patients from eight centres were included in the prospective registry. Owing to slow accrual, the trial was stopped on the advice of an independent Data and Safety Monitoring Board in the Netherlands. No significant difference in median (i.q.r.) time to functional recovery was observed between laparoscopic and open surgery in the randomized or non-randomized groups: 3 (3-5) days for OLLSversus 3 (3-3) days for LLLS; and 3 (3-3) days for ONRversus 3 (3-4) days for LNR. There were no significant differences with regard to LOS, morbidity, reoperation, readmission and mortality rates.ConclusionThis RCT comparing open and laparoscopic LLS in an ERAS setting was not able to reach a conclusion on time to functional recovery, because it was stopped prematurely owing to slow accrual. Registration number: NCT00874224 ( ).A lesson in trial design

AB - BackgroundLaparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided.MethodsIn this multicentre double-blind RCT, patients (aged 18-80years with a BMI of 18-35kg/m(2) and ASA fitness grade of III or below) requiring left lateral sectionectomy (LLS) were assigned randomly to OLLS or LLLS within an enhanced recovery after surgery (ERAS) programme. All randomized patients, ward physicians and nurses were blinded to the procedure undertaken. A parallel prospective registry (open non-randomized (ONR) versus laparoscopic non-randomized (LNR)) was used to monitor patients who were not enrolled for randomization because of doctor or patient preference. The primary endpoint was time to functional recovery. Secondary endpoints were length of hospital stay (LOS), readmission rate, overall morbidity, composite endpoint of liver surgery-specific morbidity, mortality, and reasons for delay in discharge after functional recovery.ResultsBetween January 2010 and July 2014, patients were recruited at ten centres. Of these, 24 patients were randomized at eight centres, and 67 patients from eight centres were included in the prospective registry. Owing to slow accrual, the trial was stopped on the advice of an independent Data and Safety Monitoring Board in the Netherlands. No significant difference in median (i.q.r.) time to functional recovery was observed between laparoscopic and open surgery in the randomized or non-randomized groups: 3 (3-5) days for OLLSversus 3 (3-3) days for LLLS; and 3 (3-3) days for ONRversus 3 (3-4) days for LNR. There were no significant differences with regard to LOS, morbidity, reoperation, readmission and mortality rates.ConclusionThis RCT comparing open and laparoscopic LLS in an ERAS setting was not able to reach a conclusion on time to functional recovery, because it was stopped prematurely owing to slow accrual. Registration number: NCT00874224 ( ).A lesson in trial design

KW - NUMERIC RATING-SCALE

KW - FAST-TRACK PROGRAM

KW - LIVER SURGERY

KW - RESECTION

KW - PROTOCOL

KW - OUTCOMES

KW - CANCER

U2 - 10.1002/bjs.10438

DO - 10.1002/bjs.10438

M3 - Article

C2 - 28138958

SN - 0007-1323

VL - 104

SP - 525

EP - 535

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 5

ER -