Open AccessSystematic review and meta‐analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer
Author(s) -
Michalski C. W.,
Kleeff J.,
Wente M. N.,
Diener M. K.,
Büchler M. W.,
Friess H.
Publication year - 2007
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.5716
Subject(s) - medicine , hazard ratio , confidence interval , lymphadenectomy , odds ratio , randomized controlled trial , meta analysis , pancreaticoduodenectomy , pancreatic cancer , survival rate , surgery , cancer , oncology , pancreas
Background: Although some retrospective studies of extended radical lymphadenectomy for pancreatic cancer have suggested a survival advantage, this is controversial. Methods: A literature search identified randomized controlled trials comparing extended with standard lymphadenectomy in pancreatic cancer surgery. Overall survival was analysed using hazard ratios and standard errors. Pooled estimates of overall treatment effects were calculated using a random effects model (odds ratio and 95 per cent confidence interval). Results: Of four randomized trials identified for systematic review, three were included in a meta‐analysis of survival. The log hazard ratios (standard errors) for survival for the three trials were 0·36 (0·22), − 0·15 (0·17) and − 0·21 (0·15); the weighted mean log hazard ratio for survival overall was 0·93 (95 per cent confidence interval 0·77 to 1·13), revealing no significant differences between the standard and extended procedure ( P = 0·480). Morbidity and mortality rates were also comparable, with a trend towards higher rates of delayed gastric emptying for extended lymphadenectomy. The number of resected lymph nodes was significantly higher in the extended lymphadenectomy groups ( P < 0·001). Conclusion: The extended procedure does not benefit overall survival, and there may even be a trend towards increased morbidity. Therefore extended lymphadenectomy should be performed only within adequately powered controlled trials, if at all. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.