The role of extended resection in pancreatic adenocarcinoma: is there good evidence-based justification?
Thus far, there are no studies concerning the radicality of pancreaticoduodenectomy which, in well-performed, randomized-controlled trials employing high standards of evidence-based medicine, show a benefit over extended lymphadenectomy. The results of the only two prospective randomized studies are not comparable and both are underpowered (level of evidence Ib). Therefore, it is still unclear whether extended lymphadenectomy for pancreatic carcinoma improves outcome. Only one study suggests a positive tendency toward increased survival rates in node-positive patients. Extended approaches including additional venous resection can be performed without a rise in the morbidity and mortality rates of patients with pancreatic carcinoma. In the future appropriately powered randomized trials of standard vs. extended resections may show the benefit of extended surgical resections. In addition, well powered trials of postoperative adjuvant therapies or preoperative neoadjuvant strategies together with surgical resections may identify more effective combinations showing a survival benefit in patients with pancreatic carcinoma.
Hartel
Mark
M
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Wente
Moritz N
MN
Di Sebastiano
Pierluigi
P
Friess
Helmut
H
Büchler
Markus W
MW
D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D008207:Lymphatic Metastasis; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D015203:Reproducibility of Results