Standard and extended lymphadenectomy for adenocarcinoma of the pancreatic head: a meta-analysis and systematic review

Abstract

Background and aim: Although some retrospective studies have recommended that pancreaticoduodenectomy with extended lymphadenectomy might improve the survival of patients with adenocarcinoma of the head of the pancreas, the procedure remains controversial.

Methods: Using PubMed, EMBASE, and The Cochrane Library databases, a systematic literature review was performed to identify randomized, controlled trials comparing standard and extended lymphadenectomy in pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas.

Results: Four trials including 423 patients satisfied the inclusion criteria. Extended lymphadenectomy failed to improve the overall survival of patients with adenocarcinoma of the head of the pancreas (hazard ratio 1.09; 95% confidence interval 0.84-1.41; P = 0.51). Additionally, postoperative mortality and morbidity were comparable between the standard and extended groups, while extended lymphadenectomy was associated with poor quality of life within 1 year after the operation.

Conclusions: Extended lymphadenectomy do not benefit overall survival. Considering the poor quality of life associated with extended lymphadenectomy, pancreaticoduodenectomy with standard lymphadenectomy is suitable for patients with adenocarcinoma of the head of the pancreas.

Keywords: lymph node excision; pancreatic neoplasm; pancreaticoduodenectomy.