The Value Of Extended Lymphadenectomy In Pancreaticoduodenectomy

Objective A study aimed to evaluate the clinical value of extended lymphadenectomy in pancreaticoduodenectomy for pancreatic and periampullary adenocarcinoma.Methods A total of 113 patients with Pancreatic or Periampullary Adenocarcinoma underwent pancreaticoduodenectomy from January 2010 to February 2015 in our hospital. According to the range of the lymphadenectomy, patients were divided into two groups:the standard lymph node dissection group (SLND,n=67)and the extended lymph node dissection group(ELND,n=46). The perioperative conditions, pathological data, point cumulative survival rate and survival function in patients were studied.Results There were no significant differences between the two groups in relation to age, gender and preoperative risk factors. Operation time, blood loss, blood transfusion, tomor size, morbidity in hospital, mortality and postoperative hospital stay were comparable. The mean number of lymph nodes retrieved per patient was higher in the ELND group than in the SLND group (17.7±8.99 vs 9.61±7.90;p<0.001).The incidence of postoperative diarrhea was higher in the ELND group(ELND vs SLND 18.6% vs 3.17%,p=0.014), but this symptom was disappeared usually 12 months after surgery.The local recurrence was lower in the ELND group (ELND vs SLND 6.98% vs 23.8%,p=0.034). The point cumulative survival rate of 2 and 3 years after operation was 61.3%、 53.6% in ELND group,27.9、7.1% in the SLND group (p<0.05), the survival function had significant difference(p=0.023). In the patients of pancreatic adenocarcinoma, overall survival did not differ between the two groups, when subgroups of patients were analyzed, there was a significantly (p< 0.05) longer survival rate in node negative patients after an extended rather than a standard lymphadenectomy.In patients of periampullary adenocarcinoma, ELND group showed a significant benefit in the overall survival,expecially in the patients of duodenal papillary adenocarcinoma.Conclusions 1)Extended Lymphadenectomy in Pancreaticoduodenectomy doesn’t significantly increase the morbidity and mortality rates.2) Extended Lymphadenectomy can reduce the local recurrence.3)There appears to be a trend toward longer survival treated with an extended rather than a standard lymphadenectomy in the patients of periampullary adenocarcinoma, expecially the patients of duodenal papillary adenocarcinoma.4) Extended Lymphadenectomy doesn’t improve the overall survival in the patients of pancreatic adenocarcinoma, but it may benefit the survival of node negative patients.