Surgical treatment of pancreatic cancer. Does extended lymphadenectomy provide a better outcome?
The rate of curative resection of pancreatic cancer has increased as a result of extended operations, but this has not led to any significant improvement in postoperative outcome. No definite conclusions were drawn in retrospective studies comparing outcome after standard and extended operations, and there was almost no difference in outcome between the two groups in a recent prospective randomized study. In addition, extended procedures are very stressful operations that, in most instances, impair the patient's quality of life (QOL). As a result, the need for performing extended surgery to treat pancreatic cancer has come into question. The outcome of advanced cancer in patients in whom curative resection cannot be achieved by extended operations is extremely poor, and we believe that, in such patients, priority should be given to QOL, by selecting bypass or limited operations instead. It is hoped that the value of extended surgery will be clarified by a very carefully planned multicenter prospective randomized study in the future.
Kawarada
Y
Y
First Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Das
B C
BC
Naganuma
T
T
Isaji
S
S
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome