Standard And Extended Lymphadenectomy For Adenocarcinoma Of The Pancreatic Head: A Meta-analysis And Systematic Review

Objective: To compare pancreaticoduodenectomy with standard or extended lymphadenectomyfor adenocarcinoma of the head of the pancreas.Methods: Using PubMed (January1966to June2013), EMBASE (January1988to June2013)and The Cochrane Library databases, a systematic literature review was performed to identifyrandomized controlled trials. The “risk of bias” assessment tool recommended by the CochraneHandbook (version5.1) was applied to assess the included studies. And data extraction andmeta-analysis were performed. A fixed-effect model and a random-effect model were varied withthe heterogeneity test.Results: Four trials including423patients satisfied the inclusion criteria. Extendedlymphadenectomy failed to improve the overall survival of patients with adenocarcinoma of thehead of the pancreas (hazard ratio1.10;95%confidence interval,0.86,1.40; P=0.46). HRs ofnode positive, node negative and no postoperative adjuvant therapy were1.04(95%CI=0.76,1.42;P=0.81),1.06(95%CI=0.58,1.94; P=0.85),1.16(95%CI=0.67,1.98; P=0.60) respectively.Additionally, postoperative mortality and morbidity were comparable between the standard andextended groups, while extended lymphadenectomy was associated with poor quality of life (QoL)within1year after the operation.Conclusions: Extended lymphadenectomy do not benefit overall survival and increase mortalityand morbidity. Considering the poor QoL associated with extended lymphadenectomy,pancreaticoduodenectomy with standard lymphadenectomy is suitable for patients withadenocarcinoma of the head of the pancreas.