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The Role of Extended Lymphadenectomy for Adenocarcinoma of the Head of the Pancreas: Strength of the Evidence

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

With improvements in the safety of Whipple resection in recent decades, surgeons have continued to explore the role of more extensive lymphadenectomy in hope of improving long-term survival. A systematic literature search of level I evidence addressing the role of the extent of lymphadenectomy was undertaken. Only reports of prospective, randomized controlled trials comparing pancreaticoduodenectomy with standard lymphadenectomy to pancreaticoduodenectomy with extended lymphadenectomy where information regarding survival, morbidity, mortality, the number of resected lymph nodes in each group and detailed operative technique were included. Four prospective, randomized trials comprising some 424 patients and one meta-analysis were identified. In aggregate, these studies confirmed that the number of resected lymph nodes was significantly higher in the pancreaticoduodenectomy with extended lymphadenectomy group. Morbidity and mortality rates were comparable. Postoperative diarrhea in the early months after operation was problematic in patients undergoing extended lymphadenectomy. In none of the studies was a benefit in long-term survival demonstrated. Standard pancreaticoduodenectomy continues to be the operation of choice for adenocarcinoma of the head of the pancreas.

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References

  1. Fortner JC. Regional resection of cancer of the pancreas: A new surgical approach. Surgery 1973;73:307–320.

    PubMed  CAS  Google Scholar 

  2. Takahashi S, Ogata Y, Miyazaka H, Maeda D, Murai S, Yamakata K, Tsuzuki T. Aggressive surgery for pancreatic duct cell cancer: Feasibility, validity, limitations. World J Surg 1995;19:653–660.

    Article  PubMed  CAS  Google Scholar 

  3. Cubilla AL, Fortner J, Fitzgerald PJ. Lymph node involvement in carcinoma of the pancreas area. Cancer 1978;41:880–887.

    Article  PubMed  CAS  Google Scholar 

  4. Reber HA, Ashley SW, McFadden D. Curative treatment for pancreatic neoplasms. Radical resection. Surg Clin North Am 1995;75:905–912.

    PubMed  CAS  Google Scholar 

  5. Satake K, Nishiwaki H, Yokomatsu H, Kawazoe Y, Kim K, Haku A, Umeyama K, Miyazaki I. Surgical curability and prognosis for standard versus extended resection for T1 carcinoma of the pancreas. Surg Gynecol Obstet 1992;175:259–265.

    PubMed  CAS  Google Scholar 

  6. Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 1995;117:616–623.

    Article  PubMed  CAS  Google Scholar 

  7. McFadden DW, Reber HA. Cancer of the pancreas: Radical resection—supporting view. Adv Surg 1994;27:257–272.

    PubMed  CAS  Google Scholar 

  8. Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:215–220.

    Article  PubMed  CAS  Google Scholar 

  9. Manabe TT, Ohshio G, Baba N, Miyashita T, Asano N, Tamura K, Yamaki K, Nonaka A, Tobe T. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 1989;64:1132–1137.

    Article  PubMed  CAS  Google Scholar 

  10. Tsuchiya R, Oribe T, Noda T. Size of the tumor and other factors influencing prognosis of carcinoma of the head of the pancreas. Am J Gastroenterol 1985;80:459–462.

    PubMed  CAS  Google Scholar 

  11. Tschiya R, Eto T, Tsunoda T. Radical resection of pancreatic and periampullary neoplasms. Pancreatoduodenectomy. In Braasch JW, Tompkins RK, eds. Surgical disease of the biliary tract and pancreas. Multidisciplinary management. St. Louis: Mosby, 1994, pp 570–587.

    Google Scholar 

  12. Hirata K, Sato T, Mukaiya M, Yamashiro K, Kimura M, Sasaki K, Denno R. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas. Arch Surg 1997;132:771–777.

    PubMed  CAS  Google Scholar 

  13. Ishikawa O, Ohigashi H, Sasaki Y, Kabuto T, Furukawa H, Nakamori S, Imaoka S, Iwanaga T, Kasugai T. Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery 1997;121:244–249.

    Article  PubMed  CAS  Google Scholar 

  14. Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas. Ann Surg 1998;228:508–517.

    Article  PubMed  CAS  Google Scholar 

  15. Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Comparison of morbidity and mortality and short-term outcome. Ann Surg 1999;229:613–624.

    Article  PubMed  CAS  Google Scholar 

  16. Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, Part 2. Ann Surg 2002;3:355–368.

    Article  Google Scholar 

  17. Nguyen TC, Sohn TA, Cameron JL, Lillemoe KD, Campbell KA, Coleman JA, Sauter PK, Abrams RA, Hruban RH, Yeo CJ. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg 2003;7:1–11.

    Article  PubMed  Google Scholar 

  18. Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, Abrams RA, Laheru D, Hruban RH, Yeo CJ. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—Part 3: Update on 5-year survival. J Gastrointest Surg 2005;9:1191–1206.

    Article  PubMed  Google Scholar 

  19. Nimura Y, Nagino M, Kato H, Miyagawa S, Yamaguchi A, Kinoshita T, Takao S, Takada T, Miyazaki K, Ishiyama S, Shimada H, Kawarada Y, Takeda H, Sagota K, Yasui K. Regional vs extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer. A multicenter randomized controlled trial. HPB Off J Int Hepato Pancreato Biliary Assoc 2004;6(suppl 1):2, Abstract.

    Google Scholar 

  20. Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ, Pancreas Cancer Working Group. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005;138:618–630.

    Article  PubMed  Google Scholar 

  21. Michalski CW, Kleeff J, Wente MN, Diener MK, Buchler MW, Friess H. Systemic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 2007;94:265–273.

    Article  PubMed  CAS  Google Scholar 

  22. Pawlik TM, Abdalla EK, Barnett CC, Ahmad SA, Cleary KR, Vaughey J-N, Lee JE, Evans DB, Pisters PWT. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg 2005;140:584–591, June.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michael B. Farnell

  2. Loyola University Medical Center, Maywood, IL, USA

    Gerard V. Aranha

  3. Nagoya University School of Medicine, Nagoya, Japan

    Yuji Nimura

  4. Weill Medical College, New York, NY, USA

    Fabrizio Michelassi

Authors
  1. Michael B. Farnell
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  2. Gerard V. Aranha
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  3. Yuji Nimura
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  4. Fabrizio Michelassi
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Correspondence to Michael B. Farnell.

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Farnell, M.B., Aranha, G.V., Nimura, Y. et al. The Role of Extended Lymphadenectomy for Adenocarcinoma of the Head of the Pancreas: Strength of the Evidence. J Gastrointest Surg 12, 651–656 (2008). https://doi.org/10.1007/s11605-007-0451-1

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  • DOI: https://doi.org/10.1007/s11605-007-0451-1

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