| Objective:By comparing the safety and efficacy of radical and standard lymph node dissection in pancreaticoduodenectomy,explore the clinical value of extended lymphadenectomy for patients with periampullary adenocarcinoma in pancreaticoduodenectomy.Methods:A thorough search of Pubmed,Embase,the Cochrane library and the Chinese Bio Medical Literature(CBM)databases was performed to identifyrandomized controlled trials of comparingsafety and efficacy of radical and standard lymph node dissection.Results:A total of778 patients were included in the study in the 6trials.There was no significant difference in postoperative mortality and complications between the radical and standardgroups,but the radical group have significantly higher rates of early delayed gastric emptying.The over survival of patients who suffered fromperiampullaryadenocarcinomacan not benefit from extended lymph node dissection(hazardratio1.00;95%CI 0.37-1.94).HRs of pancreatic head carcinoma,pancreatic head carcinoma with no postoperative adjuvant therapy,lymphnode negative and lymph node positive were(HR 1.05;95%CI 0.89-1.25),(OR 0.87;95%CI 0.63-1.21),(HR 1.18;95% CI 0.63 to 2.19;),(HR 1.03;95% CI 0.79 to 1.34;),respectively.The radical group have significantly higher rates of negative margins in patients with pancreatic head carcinoma(OR 1.75;95%CI1.09-2.83).The results showed that pancreaticoduodenectomy with extended lymph node dissection did not improve the postoperative survival rate,while may reduce the quality of life within 1 years after surgery.Conclusions:The over survival of patients who suffered fromperiampullaryadenocarcinomacan not benefit from extended lymph node dissection and may increase the rates of early delayed gastric emptying.Consideringthe extended lymph node dissectionmay reduce the quality of life in the early postoperative period,we recommend a standard lymphadenectomy for patients with periampullary adenocarcinoma undergoing pancreaticoduodenectomy. |
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