Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer
- 22 February 2007
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 94 (3), 265-273
- https://doi.org/10.1002/bjs.5716
Abstract
Background Although some retrospective studies of extended radical lymphadenectomy for pancreatic cancer have suggested a survival advantage, this is controversial. Methods A literature search identified randomized controlled trials comparing extended with standard lymphadenectomy in pancreatic cancer surgery. Overall survival was analysed using hazard ratios and standard errors. Pooled estimates of overall treatment effects were calculated using a random effects model (odds ratio and 95 per cent confidence interval). Results Of four randomized trials identified for systematic review, three were included in a meta-analysis of survival. The log hazard ratios (standard errors) for survival for the three trials were 0·36 (0·22), − 0·15 (0·17) and − 0·21 (0·15); the weighted mean log hazard ratio for survival overall was 0·93 (95 per cent confidence interval 0·77 to 1·13), revealing no significant differences between the standard and extended procedure (P = 0·480). Morbidity and mortality rates were also comparable, with a trend towards higher rates of delayed gastric emptying for extended lymphadenectomy. The number of resected lymph nodes was significantly higher in the extended lymphadenectomy groups (P < 0·001). Conclusion The extended procedure does not benefit overall survival, and there may even be a trend towards increased morbidity. Therefore extended lymphadenectomy should be performed only within adequately powered controlled trials, if at all.Keywords
This publication has 34 references indexed in Scilit:
- CONSORT and QUOROM guidelines for reporting randomized clinical trials and systematic reviewsAmerican Journal of Orthodontics and Dentofacial Orthopedics, 2005
- Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomyBritish Journal of Surgery, 2005
- Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancerBritish Journal of Surgery, 2005
- Extended surgery in bilio-pancreatic cancer: The Japanese experienceSeminars in Oncology, 2002
- Surgical treatment of pancreatic cancer. Does extended lymphadenectomy provide a better outcome?Journal of Hepato-Biliary-Pancreatic Surgery, 2001
- A Surgical and Pathological Based Classification of Resective Treatment of Pancreatic CancerDigestive Surgery, 1999
- Modified Standard Pancreaticoduodenectomy for the Treatment of Pancreatic Head CancerDigestion, 1999
- Role of Extended Lymph Node Dissection in the Treatment of Gastrointestinal Tumours: A Review of the LiteratureScandinavian Journal of Gastroenterology, 1995
- Preoperative Indications for Extended Pancreatectomy for Locally Advanced Pancreas Cancer Involving the Portal VeinAnnals of Surgery, 1992
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986