title: Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  The evidence for improved prognostic assessment and long-term survival for extended pancreatoduodenectomy (EPD) compared to standard pancreatoduodenectomy (SPD) in patients with carcinoma of the head of the pancreas has not been considered from only randomized controlled trials (RCTs).
  
  
  METHODS
  The aim of this study was to conduct a systematic review and meta-analysis of the outcomes comparing SPD and EPD in RCTs. Searches were performed on MEDLINE, Embase and Cochrane databases using MeSH keyword combinations: 'pancreatic cancer', 'pancreaticoduodenectomy', 'extended', 'randomized' and 'lymphadenectomy'. RCTs published up to 2014 were included. Overall post-operative survival, morbidity, 30-day mortality and length of hospital stay were the outcomes assessed.
  
  
  RESULTS
  Five eligible RCTs with 546 participants were included (EPD = 276 and SPD = 270). EPD was associated with a significantly higher number of excised lymph nodes (LNs) compared to SPD (mean difference = 15.73, 95% confidence interval (CI) = 9.41-22.04; P < 0.00001; I(2) = 88%). LN metastasis was detected in 58-68 and 55-70% of patients who had EPD and SPD, respectively. EPD did not improve overall survival (hazard ratio (HR) = 0.88, 95% CI = 0.75-1.03; P = 0.11) but did worsen post-operative morbidity compared to SPD (risk ratio (RR) = 1.23; 95% CI = 1.01-1.50; P = 0.004; I(2) = 9%). There were no differences in the 30-day mortality (RR = 0.81; 95% CI = 0.32-2.06; P = 0.66; I(2) = 0%) or length of hospital stay (mean difference = 1.39, 95% CI = -2.31 to 5.09; P = 0.46; I(2) = 67%).
  
  
  CONCLUSIONS
  SPD is associated with reduced morbidity, but equivalent long-term benefits compared to patients undergoing EPD.
authors.affiliation: Department of HPB and Liver Transplantation Surgery, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK, bobby.dasari@yahoo.com.
authors.forename: Bobby V M
authors.initials: BV
authors.lastname: Dasari
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.forename: Ravinder S
authors.initials: RS
authors.lastname: Vohra
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Smith
authors.forename: Mark A
authors.initials: MA
authors.lastname: Taylor
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic