title: A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer.
abstract: OBJECTIVE
  To prospectively evaluate the survival benefit of dissection of the nerve plexus and lymphadenectomy in patients with pancreatic head cancer.
  
  
  BACKGROUND
  Despite randomized controlled trials on the extent of surgery in pancreatic cancer, attempts have been made to perform more extended resections.
  
  
  METHODS
  A total of 244 patients were enrolled; of these, 200 were randomized to undergo standard resection or extended resection, with the latter including the dissection of additional lymph nodes and the right half of the nerve plexus around the superior mesenteric artery and celiac axis. We evaluated 167 patients from 7 centers who fulfilled all of the required criteria.
  
  
  RESULTS
  Operation time was longer and estimated blood loss was higher in the extended resection group than in the standard resection group, but the R0 resection rate was comparable. The mean number of lymph nodes retrieved per patient was higher in the extended resection group than in the standard resection group (33.7 vs 17.3; P < 0.001). The morbidity rate was slightly higher in the extended resection group than in the standard resection group. Two patients in the extended resection group died in hospital. Median survival after R0 resection was similar in the extended resection and standard resection groups (18.0 vs 19.0 months; P = 0.239) regardless of lymph node metastasis. Adjuvant chemoradiation had a positive impact on overall survival.
  
  
  CONCLUSIONS
  This study suggests that extended lymphadenectomy with dissection of the nerve plexus does not provide a significant survival benefit compared with standard resection in pancreatic head cancer. Standard resection can be performed safely and efficiently, without negatively affecting oncologic efficacy or long-term survival, when compared with extended pancreaticoduodenal resection. (NCT00679913)?
authors.affiliation: *Department of Surgery, Seoul National University College of Medicine, Seoul †Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul ‡Center for Liver Cancer, National Cancer Center, Gyeonggido §Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul ¶Department of Surgery, Chonbuk National University Medical School, Jeonbuk ‖Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu; and **Department of Surgery, Kyungpook National University College of Medicine, Daegu.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.forename: Sang Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Dong Sup
authors.initials: DS
authors.lastname: Yoon
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yu
authors.forename: Koo Jeong
authors.initials: KJ
authors.lastname: Kang
authors.forename: Sang Geol
authors.initials: SG
authors.lastname: Kim
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002447:Celiac Plexus / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D016019:Survival Analysis; D016896:Treatment Outcome