Long‐term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study

Jang, Jin Young; Kang, Jae Seung; Han, Youngmin; Heo, Jin Seok; Choi, Seong Ho; Choi, Dong Wook; Park, Sang Jae; Han, Sung Sik; Yoon, Dong Sup; Park, Joon Seong; Yu, Hee Chul; Kang, Koo Jeong; Kim, Sang Geol; Lee, Hongeun; Kwon, Wooil; Yoon, Yoo Seok; Han, Ho Seong; Kim, Sun Whe

doi:10.1002/jhbp.465

Cited by 40 publications

(36 citation statements)

References 39 publications

(52 reference statements)

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“…Recurrence after curative-intent surgery for PDAC is unfortunately a common feature and is encountered in more than 80% of patients (104)(105)(106). The recurrence can occur at the local site of resection and/or in the liver, peritoneum, lung or other distant sites.…”

Section: Resection For Recurrent Pdacmentioning

confidence: 99%

“…The recurrence can occur at the local site of resection and/or in the liver, peritoneum, lung or other distant sites. A local recurrence is encountered in almost 75% of the patients after curative-intent surgery for PDAC, while distant metastases were observed in 66%-83% of the patients (mainly liver and peritoneal) (76,104,105).…”

Section: Resection For Recurrent Pdacmentioning

confidence: 99%

“…Since most patients resected for PDAC will have distant metastases at the time of recurrence, an isolated non-invasive local recurrence is a rare appearance after resection for PDAC (104)(105)(106)(107)(108). Thus, there are few data in the literature about resection for recurrent PDAC.…”

Section: Resection For Recurrent Pdacmentioning

confidence: 99%

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Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Section: Resection For Recurrent Pdacmentioning

confidence: 99%

Section: Resection For Recurrent Pdacmentioning

confidence: 99%

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Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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“…However, subsequent studies have found that EPD does not result in survival bene ts and might increase the incidence of postoperative complications. [5][6][7][8][9][10] In 2014, the International Pancreatic Surgery Research Group (ISGPS) reached a consensus about SPD that includes the 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b lymph nodes. [11] Furthermore, some researchers reported that lymphadenectomy that includes the 12b,12c, 13, and 17 lymph nodes can be performed safely and e ciently, without negatively affecting oncologic e cacy or long-term survival, only compared with EPD.…”

Section: Introductionmentioning

confidence: 99%

Optimal Extent of Lymphadenectomy for Radical Surgery of Pancreatic Head Adenocarcinoma: A Single-center, Prospective, Randomized Controlled Study

Wang¹,

Wang²,

Chen³

et al. 2020

Preprint

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BackgroundRadical pancreaticoduodenectomy is the only possible cure for pancreatic head adenocarcinoma, and although several RCT studies have suggested the extent of lymph node dissection, this issue remains controversial. This article wanted to evaluate the survival benefit of different lymph node dissection extent for radical surgical treatment of pancreatic head adenocarcinoma.MethodsA total of 240 patients were enrolled in the study, 212 of whom were randomly divided into standard lymphadenectomy group (SG) or extended lymphadenectomy group (EG), there were 97 patients in SG and 95 patients in EG receiving the radical pancreaticoduodenectomy.ResultThe demography, histopathology and clinical characteristics were similar between the two groups. The 2-year overall survival rate in the SG was higher than the EG (39.5% vs 25.3%; p=0.034). The 2-year overall survival rate in the SG who received postoperative adjuvant chemotherapy was higher than the EG (60.7% vs 37.1%; p=0.021). There was no significant difference in the overall incidence of complications between the two groups (p=0.502). The number of peripheral blood lymphocytes of the EG was significantly lower than that in the SG at 1 week (mean [SD], 0.957[0.429] vs 1.278[0.521], p=0.001) and 1 month (mean [SD], 1.538[0.618] vs 1.917[0.796], p=.009) after operation.ConclusionIn multimodality therapy system, the efficacy of chemotherapy should be based on the appropriate lymphadenectomy extent, and the standard extent of lymphadenectomy is optimal for resectable pancreatic head adenocarcinoma. The postoperative slowing of peripheral blood lymphocyte recovery might be one of the reasons why extended lymphadenectomy did not result in survival benefits.Clinical trial registrationThis trial was registered at ClinicalTrials.gov (NCT02928081) in October 7, 2016. https://clinicaltrials.gov/

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“…Во многом неудовлетворительные результаты хирургического лечения протоковой аденокарциномы поджелудочной железы определяются высокой частотой местных рецидивов -локальных, перитонеальных и в оставшейся части паренхимы. По данным большинства исследователей [3], частота рецидивов достаточно стабильна и находится в пределах 30-47,6%. К факторам риска ранних (в течение года) перитонеальных рецидивов относят резекцию портомезентериального венозного сегмента, длительность операции (648 мин и более), большую кровопотерю (2179 мл и более), гемотрансфузию, размер опухоли, инвазию в воротную вену, артериальную инвазию и дифференцировку опухоли.…”

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