Document Detail

The role of extended lymphadenectomy for adenocarcinoma of the head of the pancreas: strength of the evidence.
MedLine Citation:
PMID:  18085343     Owner:  NLM     Status:  MEDLINE    
With improvements in the safety of Whipple resection in recent decades, surgeons have continued to explore the role of more extensive lymphadenectomy in hope of improving long-term survival. A systematic literature search of level I evidence addressing the role of the extent of lymphadenectomy was undertaken. Only reports of prospective, randomized controlled trials comparing pancreaticoduodenectomy with standard lymphadenectomy to pancreaticoduodenectomy with extended lymphadenectomy where information regarding survival, morbidity, mortality, the number of resected lymph nodes in each group and detailed operative technique were included. Four prospective, randomized trials comprising some 424 patients and one meta-analysis were identified. In aggregate, these studies confirmed that the number of resected lymph nodes was significantly higher in the pancreaticoduodenectomy with extended lymphadenectomy group. Morbidity and mortality rates were comparable. Postoperative diarrhea in the early months after operation was problematic in patients undergoing extended lymphadenectomy. In none of the studies was a benefit in long-term survival demonstrated. Standard pancreaticoduodenectomy continues to be the operation of choice for adenocarcinoma of the head of the pancreas.
Michael B Farnell; Gerard V Aranha; Yuji Nimura; Fabrizio Michelassi
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Publication Detail:
Type:  Comparative Study; Journal Article; Review     Date:  2007-12-18
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  12     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-14     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  651-6     Citation Subset:  IM    
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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MeSH Terms
Adenocarcinoma / surgery*
Lymph Node Excision / methods*
Meta-Analysis as Topic
Pancreatic Neoplasms / surgery*
Randomized Controlled Trials as Topic

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