Role of extended lymphadenectomy in the treatment of pancreatic head adenocarcinoma: review and meta‐analysis

Abstract

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.

Extended versus standard lymphadenectomy in patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective randomized single center trial

“…In the present study the number of removed lymph nodes was 13.6 ± 7.9 in the SLA group and 25.3 ± 11.8 in the ELA group, which is comparable to data of the current literature [16][17][18][19]35]. Thus, the ELA in the present study resulted in a significantly increased number of resected lymph nodes without increasing significantly the amount of lymph node metastases.…”

“…In our patient collective the mean number of positive lymph nodes was 3.3 ± 4.7 in the ELA group compared to 2.2 ± 2.7 in the SLA group. This finding is also comparable to the former randomized and nonrandomized studies [32,33,35]. The additional excision of the lymph node groups 9, 12p/b, 14a-v, and 16a1,a2,b1 did not result in a higher incidence of lymph node metastases overall.…”

“…It must be postulated that the outcomes for cancers of the periamullary region are considerably different. In contrast the great majority of patients included in several metaanalyses [32,35] are provided by the study of Yeo and colleagues [19] who had included all types of periampullary carcinoma. The current study was designed similarly.…”

Does sentinel node biopsy play a role in pancreatic adenocarcinoma?

“…This fact is mainly correlated with the high capacity of the pancreatic adenocarcinoma to spread via lymphatic route; therefore, it has been demonstrated that lymph node metastases develop early in the course of disease in pancreatic adenocarcinomas and represent one of the most important prognostic factors for the long-term survival. However, the extent of the lymph node dissection has been permanently debated, different opinions being reported so far; while the European countries sustain the idea that an extended lymph node dissection in pancreatic adenocarcinoma does not improve the survival and, moreover, increases the postoperative morbidity rates, the Eastern countries consider that such a lymph node dissection is perfectly justified in order to increase the chances for an improved survival [13][14][15][16][17] .…”

Προγνωστικοί Δείκτες Στον Καρκίνο Του Παγκρέατος Και Συσχετισμός Τους Με Επιπλοκές Και Επιβίωση

“…Η ανάλυση όλων των μελετών, όπως και η ανάλυση ξεχωριστά των τυχαιοποιημένων και των μη τυχαιοποιημένων μελέτων δεν ανέδειξαν κάποια σημαντική βελτίωση της επιβίωσης μετά από εκτεταμένο λεμφαδενικό καθαρισμό (Εικόνα 15). 283 Συνεπάγεται ότι παρά τις αρχικές ενθαρρυντικές μελέτες, ο εκτεταμένος λεμφαδενικός καθαρισμός κατά την αντιμετώπιση του καρκίνου της κεφαλής του παγκρέατος δεν συνεισφέρει στην βελτίωση της επίβιωσης και την μείωση της τοπικής υποτροπής των ασθενών, ενώ ταυτόχρονα αυξάνει τον κίνδυνο εμφάνισης μετεγχειρητικών διαρροιών, γι΄αυτό και δεν συστήνεται η εφαρμογή του.…”