Current status of radical systematic lymphadenectomy in pancreatic cancer--a review of the literature.
BACKGROUND
Pancreatic cancer is the fourth most common cause of death in malignancies with an incidence of 8-12 cases per 100000 in western world. In spite of numerous modifications in therapeutical approaches, prognosis has not improved.


METHODS
In the last few years numerous studies have been performed to reduce tumor mortality with more radical surgical procedures. Several articles of the last 15 years have been investigated to objectivate the benefit of extended lymphadenectomy in pancreatic surgery. Staging of the cancers, prognostic factors, technique and interpretation of lymphadenectomy have been analysed


RESULTS
All studies document a lowered perioperative mortality in pancreatic resections. The procedure is counted as a standardized and safe one. However, several controversies exist. The distinct staging systems in Japan and the western world aggravate the comparison in all studies. Japanese authors in mostly retrospective analyses seem to document a survival benefit by radical surgery. Similar results could not be achieved by western authors.


CONCLUSIONS
Over all, a significant benefit in extreme radical surgery could not bee found. However, there are indications of subgroups of patients in whom extended lymphadenectomy might be beneficial. This subgroup should be defined only by large multicentric, prospective, randomized studies.
Peiper
Matthias
M
Klinik und Poliklinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heinrich-Universität, Moorenstrasse 5, 40225 Düsseldorf, Germany. matthias.peiper@uni-duesseldorf.de
Bölke
E
E
Orth
K
K
Hosch
S B
SB
Rehders
A
A
Matthaei
H
H
Knoefel
W T
WT
D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome