Abstract | BACKGROUND: OBJECTIVES: The goal is to evaluate the role of extended lymph node dissection in pancreatic head adenocarcinoma and to review how it affects survival, morbidity, mortality and post-operative quality of life. METHODS: A computerized search was made of the Medline database from January 1973 to October 2012. Fifteen non-duplicated studies, four randomized and 11 non-randomized, comparing extended radical pancreaticoduodenectomy (ERP) and standard pancreaticoduodenectomy were reviewed. Five-year overall survivals were compared using the MetaXL software in eight of these studies, where the necessary data were available. RESULTS: The 5-year survival after ERP ranged from 6 to 33.4% and the local recurrence incidence from 8 to 36.1%, while the incidence of severe diarrhoea, one of the main complications, ranged from 10.8 to 42.4%. Meta-analysis showed that there was no significant difference in the 5-year overall survival (95% confidence interval (CI): -0.21-0.20, Z=0.07, P=0.94) for randomized control trials, (95% CI: -0.51-0.02, Z=1.85, P=0.07) for non-randomized control trials and (95% CI: -0.26-0.06, Z=1.20, P=0.23) for all the studies. CONCLUSIONS: Although ERP is a safe procedure, it did not offer a significant improvement in survival, while at the same time leading to an increased incidence of severe diarrhoea for at least 1 year, thus leaving the standard pancreaticoduodenectomy as the surgical method of choice for the treatment of pancreatic head adenocarcinoma.
|
Authors | Christos Svoronos, Georgios Tsoulfas, Anastasios Katsourakis, Georgios Noussios, Euthymmios Chatzitheoklitos, N Georgios Marakis |
Journal | ANZ journal of surgery
(ANZ J Surg)
Vol. 84
Issue 10
Pg. 706-11
(Oct 2014)
ISSN: 1445-2197 [Electronic] Australia |
PMID | 24165093
(Publication Type: Journal Article, Meta-Analysis, Review)
|
Copyright | © 2013 Royal Australasian College of Surgeons. |
Topics |
- Adenocarcinoma
(pathology, surgery)
- Humans
- Lymph Node Excision
(methods)
- Lymphatic Metastasis
- Pancreatic Neoplasms
(pathology, surgery)
- Pancreaticoduodenectomy
(methods)
- Quality of Life
- Survival Rate
|