title: Meta-analysis of the efficacies of extended and standard pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas.
abstract: BACKGROUND
  The purpose of the present study was to evaluate the efficacy of extended pancreatoduodenectomy (EPD) and standard pancreatoduodenectomy (SPD) for ductal adenocarcinoma of the head of the pancreas via meta-analysis.
  
  
  METHODS
  Relevant articles (published between 1995 and 2012) were compiled from online data sources. A total of nine studies satisfied the selection criteria, including a total of 973 patients (478 in the SPD group and 495 in the EPD group). Evaluation parameters included 1-, 3-, and 5-year survival, as well as mortality, morbidity, and specific morbidity outcomes.
  
  
  RESULTS
  Meta-analysis revealed (1) differences in morbidity (Odds ratio [OR] = 1.740; 95 % confidence interval [CI], 0.840-3.600; P = 0.140), mortality (OR = 0.890; 95 % CI, 0.560-1.400; P = 0.620), 1-year overall survival (OS) rate (OR = 1.20; 95 % CI, 0.490-2.930; P = 0.69), 3-year OS rate (OR = 0.770; 95 % CI, 0.460-1.280; P = 0.190), and 5-year OS rate (OR = 1.12; 95 % CI, 0.690-1.810; P = 0.560) were not significant between EPD and SPD. (2) For bile leak (OR = 2.640; 95 % CI, 1.040-6.700; P = 0.040), pancreatic leak (OR = 1.740; 95 % CI, 1.040-2.91; P = 0.030), delayed gastric emptying (OR = 2.090; 95 % CI, 1.240-3.520; P = 0.006), and lymphatic fistula (OR = 6.120; 95 % CI, 1.06-35.320; P = 0.040) differences between EPD and SPD were significant, whereas other specific morbidities were not significantly different.
  
  
  CONCLUSIONS
  Extended pancreatoduodenectomy does not improve 1-, 3-, 5-year OS rates compared to SPD and there is a trend toward increased bile leak, pancreatic leak, delayed gastric emptying, and lymphatic fistula after EPD.
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, Affiliated Jiangsu Cancer Hospital of Nanjing Medical University, Nanjing, 210009, People's Republic of China.
authors.forename: Jingfeng
authors.initials: J
authors.lastname: Sun
authors.forename: Yinxue
authors.initials: Y
authors.lastname: Yang
authors.forename: Xuan
authors.initials: X
authors.lastname: Wang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yu
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Song
authors.forename: Hewei
authors.initials: H
authors.lastname: Zhao
authors.forename: Jianfei
authors.initials: J
authors.lastname: Wen
authors.forename: Yong
authors.initials: Y
authors.lastname: Du
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Yewei
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D015996:Survival Rate