Advertisement

World Journal of Surgery

, Volume 38, Issue 10, pp 2708–2715 | Cite as

Meta-analysis of the Efficacies of Extended and Standard Pancreatoduodenectomy for Ductal Adenocarcinoma of the Head of the Pancreas

  • Jingfeng Sun
  • Yinxue Yang
  • Xuan Wang
  • Zhen Yu
  • Ting Zhang
  • Jun Song
  • Hewei Zhao
  • Jianfei Wen
  • Yong Du
  • Wan Yee Lau
  • Yewei Zhang
Article

Abstract

Background

The purpose of the present study was to evaluate the efficacy of extended pancreatoduodenectomy (EPD) and standard pancreatoduodenectomy (SPD) for ductal adenocarcinoma of the head of the pancreas via meta-analysis.

Methods

Relevant articles (published between 1995 and 2012) were compiled from online data sources. A total of nine studies satisfied the selection criteria, including a total of 973 patients (478 in the SPD group and 495 in the EPD group). Evaluation parameters included 1-, 3-, and 5-year survival, as well as mortality, morbidity, and specific morbidity outcomes.

Results

Meta-analysis revealed (1) differences in morbidity (Odds ratio [OR] = 1.740; 95 % confidence interval [CI], 0.840–3.600; P = 0.140), mortality (OR = 0.890; 95 % CI, 0.560–1.400; P = 0.620), 1-year overall survival (OS) rate (OR = 1.20; 95 % CI, 0.490–2.930; P = 0.69), 3-year OS rate (OR = 0.770; 95 % CI, 0.460–1.280; P = 0.190), and 5-year OS rate (OR = 1.12; 95 % CI, 0.690–1.810; P = 0.560) were not significant between EPD and SPD. (2) For bile leak (OR = 2.640; 95 % CI, 1.040–6.700; P = 0.040), pancreatic leak (OR = 1.740; 95 % CI, 1.040–2.91; P = 0.030), delayed gastric emptying (OR = 2.090; 95 % CI, 1.240–3.520; P = 0.006), and lymphatic fistula (OR = 6.120; 95 % CI, 1.06–35.320; P = 0.040) differences between EPD and SPD were significant, whereas other specific morbidities were not significantly different.

Conclusions

Extended pancreatoduodenectomy does not improve 1-, 3-, 5-year OS rates compared to SPD and there is a trend toward increased bile leak, pancreatic leak, delayed gastric emptying, and lymphatic fistula after EPD.

Keywords

Pancreatic Cancer Gastric Emptying Bile Leak Homogeneity Test Pancreatic Leak 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

No benefits in any form have been received or will be received by any of the authors from a commercial party related directly or indirectly to the subject of this article. This work was supported by the Special Funds of the National Natural Science Foundation of China (61371066), Natural Science Foundation of Jiangsu Province (SBK2011856), Key Medical Talents of Jiangsu Province (RC2011090), and 333 program for high level talents of Jiangsu Province (grant no. 2011III-2640).

References

  1. 1.
    Feig C, Gopinathan A, Neesse A et al (2012) The pancreas cancer microenvironment. Clin Cancer Res 18(16):4266–4276PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Fortner JG (1973) Regional resection and pancreatic carcinoma. Surgery 73(5):799–800Google Scholar
  3. 3.
    Pedrazzoli S, DiCarlo V, Dionigi R et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228(4):508–517PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Pedrazzoli S, Beger HG, Obertop H et al (1999) A surgical and pathological based classification of resective treatment of pancreatic cancer. Summary of an international workshop on surgical procedures in pancreatic cancer. Dig Surg 16(4):337–345PubMedCrossRefGoogle Scholar
  5. 5.
    Huang ZY, Ma J, Pei F, Yang J et al (2013) Meta-analysis of temporary versus no clamping in TKA. Orthopedics 36(7):543–550PubMedCrossRefGoogle Scholar
  6. 6.
    Henne-Bruns D, Kremer B, Meyer-Pannwitt U et al (1993) Partial duodenopancreatectomy with radical lymphadenectomy in patients with pancreatic and periampullary carcinomas: initial results. Hepatogastroenterology 40(2):145–149PubMedGoogle Scholar
  7. 7.
    Henne-Bruns D, Vogel I, Luttges J et al (1998) Ductal adenocarcinoma of the pancreas head: survival after regional versus extended lymphadenectomy. Hepatogastroenterology 45(21):855–866PubMedGoogle Scholar
  8. 8.
    Henne-Bruns D, Vogel I, Luttges J et al (2000) Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications and survival after regional versus extended lymphadenectomy. World J Surg 24(5):595–601 Discussion 601–602PubMedCrossRefGoogle Scholar
  9. 9.
    Gazzaniga GM, Cappato S, Papadia F et al (2001) D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer. Hepatogastroenterology 48(41):1471–1478PubMedGoogle Scholar
  10. 10.
    Yeo CJ, Cameron JL, Sohn TA et al (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229(5):613–622 Discussion 622–614PubMedCrossRefGoogle Scholar
  11. 11.
    Yeo CJ, Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphade nectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236(3):355–366 discussion 366–368PubMedCrossRefGoogle Scholar
  12. 12.
    Iacono C, Accordini S, Bortolasi L et al (2002) Results of pancreaticoduodenectomy for pancreatic cancer: extended versus standard procedure. World J Surg 26(11):1309–1314PubMedCrossRefGoogle Scholar
  13. 13.
    Popiela T, Kedra B, Sierzega M (2002) Does extended lymphadenectomy improve survival of pancreatic cancer patients? Acta Chir Belg 102(2):78–82PubMedGoogle Scholar
  14. 14.
    Capussotti L, Massucco P, Ribero D et al (2003) Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 138(12):1316–1322PubMedCrossRefGoogle Scholar
  15. 15.
    Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138(4):618–628 Discussion 628–630PubMedCrossRefGoogle Scholar
  16. 16.
    Nimura Y, Nagino M, Takao S et al (2012) Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 19(3):230–241PubMedCrossRefGoogle Scholar
  17. 17.
    Nimura Y, Nagino M, Kato H, et al (2004) Regional versus extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer: a multicenter, randomized controlled trial. HPB 6 (Suppl 1):2 (abstract)Google Scholar
  18. 18.
    Ishikawa O, Ohhigashi H, Sasaki Y et al (1988) Practical usefulness of lymphatic and connective tissue clearance for carcinoma of the pancreas head. Ann Surg 208(2):215–220PubMedCrossRefGoogle Scholar
  19. 19.
    Manabe T, Ohshio G, Baba N et al (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 64(5):1132–1137PubMedCrossRefGoogle Scholar
  20. 20.
    Nagakawa T, Kurachi M, Konishi K et al (1982) Translateral retroperitoneal approach in radical surgery for pancreatic carcinoma. Jpn J Surg 12(3):229–233PubMedCrossRefGoogle Scholar
  21. 21.
    Ishikawa O, Ohhigashi H, Sasaki Y et al (1998) Practical usefulness of lymphatic and connective tissue clearance for carcinoma of the pancreas head. Ann Surg 208(2):215–220CrossRefGoogle Scholar
  22. 22.
    Manabe T, Ohshio G, Baba N et al (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 64(5):1132–1137PubMedCrossRefGoogle Scholar
  23. 23.
    Nagakawa T, Konishi I, Ueno K et al (1991) Surgical treatment of pancreatic cancer. The Japanese experience. Int J Pancreatol 9(1):135–143PubMedGoogle Scholar
  24. 24.
    Nagakawa T, Kobayashi H, Ueno K et al (1994) Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 73(4):1155–1162PubMedCrossRefGoogle Scholar
  25. 25.
    Nakao A, Harada A, Nonami T et al (1995) Lymph node metastases in carcinoma of the head of the pancreas region. Br J Surg 82(3):399–402PubMedCrossRefGoogle Scholar
  26. 26.
    Kayahara M, Nagakawa T, Ueno K et al (1995) Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 117(6):616–623PubMedCrossRefGoogle Scholar
  27. 27.
    Michalski CW, Kleeff J, Wente MN et al (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94(3):265–273PubMedCrossRefGoogle Scholar
  28. 28.
    Gazzaniga GM, Cappato S, Papadia F et al (2001) D1 versus D2 in surgical therapy of pancreatic head cancer. Hepatogastroenterology 48(41):1471–1478PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Jingfeng Sun
    • 1
  • Yinxue Yang
    • 2
  • Xuan Wang
    • 1
  • Zhen Yu
    • 4
  • Ting Zhang
    • 5
  • Jun Song
    • 3
  • Hewei Zhao
    • 1
  • Jianfei Wen
    • 1
  • Yong Du
    • 6
  • Wan Yee Lau
    • 7
  • Yewei Zhang
    • 1
  1. 1.Department of Hepatobiliary & Pancreatic SurgeryAffiliated Jiangsu Cancer Hospital of Nanjing Medical UniversityNanjingPeople’s Republic of China
  2. 2.Department of General SurgeryAffiliated Hospital of Ningxia Medical UniversityYinchuanPeople’s Republic of China
  3. 3.Department of General SugeryAffiliated Hospital of Xuzhou Medical CollegeXuzhouPeople’s Republic of China
  4. 4.Department of GeriatricsSecond Affiliated Hospital of Nanjing Medical UniversityNanjingPeople’s Republic of China
  5. 5.Department of OncologyAffiliated Jiangsu Cancer Hospital of Nanjing Medical UniversityNanjingPeople’s Republic of China
  6. 6.Department of PaediatricsAffiliated Hospital of Ningxia Medical UniversityYinchuanPeople’s Republic of China
  7. 7.Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital ShatinHong KongChina

Personalised recommendations