Meta-Analysis of The Efficacy of Standard and Extended Radical Resection for Carcinoma of The Head of Pancreas_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Jingfeng , WEN Jianfei , ZHAO Hewei , ZHENG Suwen ,  ZHANG Yewei

Department of General Surgery， The Affiliated Tumor Hospital of Jiangsu Province， Nanjing Medical University， Nanjing 210009， Jiangsu Province， China;

Corresponding author：

ZHANG Yewei, Email: zhangyewei@njmu.edu.cn

Keywords：

Carcinoma of head of pancreas; Standard radical resection; Extended radical resection; Survival rate; Meta-analysis

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Objective 　To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis.　
Methods 　Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis.　
Results 　A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）.
Conclusion 　Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation

Citation： SUN Jingfeng,WEN Jianfei,ZHAO Hewei,ZHENG Suwen,ZHANG Yewei,.. Meta-Analysis of The Efficacy of Standard and Extended Radical Resection for Carcinoma of The Head of Pancreas. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(9): 1023-1028. doi: Copy

1.	崔玖洁，王理伟. 晩期胰腺癌内科治疗的现状与思考[J]. 实用肿瘤杂志， 2012， 27(3)：209-212.
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3.	Pedrazzoli S， DiCarlo V， Dionigi R， et al. Standard versus exte-nded lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas： a multicenter， prospective， randomized study. Lymp-hadenectomy Study Group[J]. Ann Surg， 1998， 228(4)： 508-517.
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5.	Yeo CJ， Cameron JL， Lillemoe KD， et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma， part 2： randomized controlled trial evaluating survival， morbidity， and mortality[J]. Ann Surg， 2002， 236 (3)： 355-368.
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7.	Nimura Y， Nagino M， Takao S， et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas： long-term results of a Japanese multicenter randomized controlled trial[J]. Hepatobiliary Pancreat Sci， 2012， 19(3)：230-241.
8.	Henne-Bruns D， Kremer B， Meyer-Pannwitt U， et al. Partial duodenopancreatectomy with radical lymphadenectomy in patients with pancreatic and periampullary carcinomas： initial results[J]. Hepatogastroenterology， 1993， 40(2)：145-149.
9.	Henne-Bruns D， Vogel I， Lüttges J， et al. Ductal adenocarcinomaof the pancreas head： survival after regional versus extended lymphadenectomy[J]. Hepatogastroenterology， 1998， 45(21)： 855-866.
10.	Henne-Bruns D， Vogel I， Lüttges J， et al. Surgery for ductaladenocarcinoma of the pancreatic head： staging， complications， and survival after regional versus extended lymphadenectomy[J]. World J Surg， 2000， 24(5)： 595-602.
11.	Gazzaniga GM， Cappato S， Papadia F， et al. D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer[J]. Hepatogastroenterology， 2001， 48(41)： 1471-1478.
12.	Iacono C， Accordini S， Bortolasi L， et al. Results of pancreaticoduodenectomy for pancreatic cancer： extended versus standard procedure[J]. World J Surg， 2002， 26(11)： 1309-1314.
13.	Capussotti L， Massucco P， Ribero D， et al. Extended lymphadenectomy and vein resection for pancreatic head cancer：outcomes and implications for therapy[J]. Arch Surg， 2003， 138 (11)：1316-1322.
14.	彭承宏，陈宁泉. 正确把握胰腺癌扩大切除手术指征[J]. 肝胆外科志， 2005， 13(1)：8-9.
15.	Ishikawa O， Ohhigashi H， Sasaki Y， et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head[J]. Ann Surg， 1988， 208(2) ： 215-220.
16.	Manabe T， Ohshio G， Baba N， et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas[J]. Cancer， 1989， 64(5)：1132-1137.
17.	Nagakawa T， Kurachi M， Konishi K， et al. Translateral retropefitoneal approach in radical surgery for pancreatic carcinoma[J]. Jpn J Surg， 1982， 12(3)：229-233.
18.	Pavlidis TE， Pavlidis ET， Sakantamis AK. Current opinion on lymphadenectomy in pancreaticcancer surgery[J]. Hepatobiliary Pancreat Dis Int， 2011， 10(1)：21-25.
19.	Nagakawa T， Konishi I， Ueno K， et al. Surgical treatment of pancreatic cancer. The Japanese experience[J]. Int J Panereatol，.
20.	Nagakawa T， Kobayashi H， Ueno K， et al. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas[J]. Cancer， 1994， 73(4)：1155-1162.
21.	Nakao A， Harada A， Nonami T， et al. Lymph node metastases in carcinoma of the head of the pancreas region[J]. Br J Surg， 1995， 82(3)：399-402.
22.	Kayahara M， Nagakawa T， Ueno K， et al. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexusinvasion[J]. Surgery， 1995， 117(6)：616-623.
23.	蒋永剑，阎九亮，金忱，等. 根治性切除胰头癌150例患者淋巴结转移的分布和特点[J]. 中华肝胆外科杂志， 2012， 18(7)：294-295.
24.	李文英，张晓峰，曹淑红. 胰腺癌手术患者115例的预后分析[J]. 中国老年学杂志， 2011， 31(15)：2867-2869.
25.	Yoshida T， Matsumoto T， Sasaki A， et al. Outcome of paraaortie node-positive pancreatic headandbileduct adenocarcinoma[J]. Am J Surg， 2004， 187(6)：736-740.
26.	(5) ：613-622.
27.	， 9(2)：135-143.

1. 崔玖洁，王理伟. 晩期胰腺癌内科治疗的现状与思考[J]. 实用肿瘤杂志， 2012， 27(3)：209-212.
2. 蒋奎荣，苗毅. 胰头癌扩大根治术的利与弊：循证分析结果[J]. 中华外科杂志， 2007， 45(1)：9-16.
3. Pedrazzoli S， DiCarlo V， Dionigi R， et al. Standard versus exte-nded lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas： a multicenter， prospective， randomized study. Lymp-hadenectomy Study Group[J]. Ann Surg， 1998， 228(4)： 508-517.
4. Yeo CJ， Cameron JL， Sohn TA， et al . Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma：comparison of morbidity and mortality and short-term outcome[J]. Ann Surg， 1999，.
5. Yeo CJ， Cameron JL， Lillemoe KD， et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma， part 2： randomized controlled trial evaluating survival， morbidity， and mortality[J]. Ann Surg， 2002， 236 (3)： 355-368.
6. Farnell MB， Pearson RK， Sarr MG， et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma[J]. Surgery， 2005， 138(4)： 618-630.
7. Nimura Y， Nagino M， Takao S， et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas： long-term results of a Japanese multicenter randomized controlled trial[J]. Hepatobiliary Pancreat Sci， 2012， 19(3)：230-241.
8. Henne-Bruns D， Kremer B， Meyer-Pannwitt U， et al. Partial duodenopancreatectomy with radical lymphadenectomy in patients with pancreatic and periampullary carcinomas： initial results[J]. Hepatogastroenterology， 1993， 40(2)：145-149.
9. Henne-Bruns D， Vogel I， Lüttges J， et al. Ductal adenocarcinomaof the pancreas head： survival after regional versus extended lymphadenectomy[J]. Hepatogastroenterology， 1998， 45(21)： 855-866.
10. Henne-Bruns D， Vogel I， Lüttges J， et al. Surgery for ductaladenocarcinoma of the pancreatic head： staging， complications， and survival after regional versus extended lymphadenectomy[J]. World J Surg， 2000， 24(5)： 595-602.
11. Gazzaniga GM， Cappato S， Papadia F， et al. D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer[J]. Hepatogastroenterology， 2001， 48(41)： 1471-1478.
12. Iacono C， Accordini S， Bortolasi L， et al. Results of pancreaticoduodenectomy for pancreatic cancer： extended versus standard procedure[J]. World J Surg， 2002， 26(11)： 1309-1314.
13. Capussotti L， Massucco P， Ribero D， et al. Extended lymphadenectomy and vein resection for pancreatic head cancer：outcomes and implications for therapy[J]. Arch Surg， 2003， 138 (11)：1316-1322.
14. 彭承宏，陈宁泉. 正确把握胰腺癌扩大切除手术指征[J]. 肝胆外科志， 2005， 13(1)：8-9.
15. Ishikawa O， Ohhigashi H， Sasaki Y， et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head[J]. Ann Surg， 1988， 208(2) ： 215-220.
16. Manabe T， Ohshio G， Baba N， et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas[J]. Cancer， 1989， 64(5)：1132-1137.
17. Nagakawa T， Kurachi M， Konishi K， et al. Translateral retropefitoneal approach in radical surgery for pancreatic carcinoma[J]. Jpn J Surg， 1982， 12(3)：229-233.
18. Pavlidis TE， Pavlidis ET， Sakantamis AK. Current opinion on lymphadenectomy in pancreaticcancer surgery[J]. Hepatobiliary Pancreat Dis Int， 2011， 10(1)：21-25.
19. Nagakawa T， Konishi I， Ueno K， et al. Surgical treatment of pancreatic cancer. The Japanese experience[J]. Int J Panereatol，.
20. Nagakawa T， Kobayashi H， Ueno K， et al. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas[J]. Cancer， 1994， 73(4)：1155-1162.
21. Nakao A， Harada A， Nonami T， et al. Lymph node metastases in carcinoma of the head of the pancreas region[J]. Br J Surg， 1995， 82(3)：399-402.
22. Kayahara M， Nagakawa T， Ueno K， et al. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexusinvasion[J]. Surgery， 1995， 117(6)：616-623.
23. 蒋永剑，阎九亮，金忱，等. 根治性切除胰头癌150例患者淋巴结转移的分布和特点[J]. 中华肝胆外科杂志， 2012， 18(7)：294-295.
24. 李文英，张晓峰，曹淑红. 胰腺癌手术患者115例的预后分析[J]. 中国老年学杂志， 2011， 31(15)：2867-2869.
25. Yoshida T， Matsumoto T， Sasaki A， et al. Outcome of paraaortie node-positive pancreatic headandbileduct adenocarcinoma[J]. Am J Surg， 2004， 187(6)：736-740.
26. (5) ：613-622.
27. ， 9(2)：135-143.

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Meta-Analysis of The Efficacy of Standard and Extended Radical Resection for Carcinoma of The Head of Pancreas

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