A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: A meta-analysis of 1909 patients

Iqbal, Nayyer; Lovegrove, Richard E.; Tilney, H. S.; Abraham, Ajit; Bhattacharya, Satya; Tekkis, Paris; Kocher, Hemant M.

doi:10.1016/j.ejso.2008.01.002

Cited by 81 publications

(45 citation statements)

References 40 publications

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“…24 Previous meta-analyses have also both demonstrated no survival differences with EPD. 25,26 However, one of these analyses included predominately nonrandomized studies (13 out of 16 included studies) 25 and the other one 26 rather than analyzing time-to-event data which would be the gold standard in reporting survival data, proportion of patients surviving at different time points were considered. Furthermore, another large randomized controlled trial (RCT) comparing EPD with SPD has been published.…”

Section: Introductionmentioning

confidence: 99%

Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials

Dasari

Pasquali

Vohra

et al. 2015

Journal of Gastrointestinal Surgery

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Section: Introductionmentioning

confidence: 99%

Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials

Dasari

Pasquali

Vohra

et al. 2015

Journal of Gastrointestinal Surgery

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“…This is in contrast with the traditional thought that when positive para-aortic nodes have been detected, a systemic disease may occur, and surgical resection should be abandoned [13][14][15][16] . On the other hand, extended lymphadenectomy failed the target of prolonging long term survival after PD for pancreatic head cancer [17][18][19][20] . There are increasing reports of long-term survival after resection of pancreatic cancer with PALNS+ [6,7,21,22] , and, based on other prognostic parameters, more selective surgical indication has been suggested.…”

Section: Discussionmentioning

confidence: 99%

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

et al. 2017

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AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor's grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) Retrospective Cohort Study had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. Onehundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. ORIGINAL ARTICLE CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors. Core tip: Para-aortic node involvement by pancreatic cancer is traditionally considered as an advanced disease with poor prognosis. We retrospectively examined our experience of 151 patients with pancreatic cancer who underwent resection and para-aortic lymph nodes sampling. Disease-free and overall survival were worse in patients with para-aortic nodes metastases, but multivariate analysis showed that para-aortic node involvement is not an independent prognostic factor after resection of pancreatic cancer. So, the decision to make pancreatic resection should not be based on the paraaortic node status only.Sperti C, Gruppo M, Blandamura S, Valmasoni M, Pozza G, Passuello N, Beltrame V, Moletta L. Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer.

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“…Z kolei w metaanalizie obejmującej 16 badań przeprowadzonych u 1909 chorych (865 PD i 1044 LPD) oraz 3 badania z randomizacją z 454 pacjentami (226 PD i 228 LPD) częstość występownia powikłań okołoopera-cyjnych była podobna w obu grupach, z wyjątkiem opóź-nienia opróżniania żołądka, które było znacząco mniejsze u chorych po PD [27]. Z kolei czas operacji był znacząco dłuższy w przypadku LPD (o 49 min) [27].…”

Section: Rozszerzona Limfadenektomiaunclassified

Surgical treatment of pancreatic cancer – randomized controlled trials

Andrén‐Sandberg¹,

Hedberg²,

Jurałowicz³

et al. 2011

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Słowa kluczowe: rak trzustki, leczenie chirurgiczne, badania z randomizacją. Keys words: pancreatic cancer, surgical treatment, randomized trials.Adres do korespondencji: prof. dr hab. n. med. Ewa Małecka-Panas, Klinika Chorób Przewodu Pokarmowego, Uniwersytet Medyczny, ul. Kopcińskiego 22, 90-153 Łódź, tel./faks +48 42 678 64 80, e-mail: ewuncia@poczta.onet.pl Artykuł poglądowy/Review paper StreszczeniePodejmowanie decyzji klinicznych w każdej dziedzinie medycyny powinno być oparte na evidence-based medicine, czyli dowodach płynących z dużych, dobrze zaprojektowanych i przeprowadzonych badań klinicznych. W naukowej hierarchii ważności najwyższe miejsce zajmują metaanalizy, zwłaszcza te oparte na ocenie badań klinicznych z randomizacją. W artykule tym autorzy zebrali wyniki wszystkich metaanaliz i klinicznych badań z randomizacją dotyczących chirurgicznego leczenia raka części zewnątrzwydzielniczej trzustki. Przeszukano bazę PubMed, używając słów pancreatic cancer i randomized controlled trials, a następnie przeanalizowano wszystkie dostępne w pełnej wersji artykuły odpowiadające słowom kluczowym, często znajdując w nich odniesienia do kolejnych badań. Niniejsza publikacja jest próbą zebrania wyników istotnych badań dotyczących postępowania okołooperacyjne-go u chorych na raka trzustki, w tym skuteczności przedoperacyjnego drenażu dróg żółciowych, technik zespolenia trzustkowo-jelitowego i rozszerzonej limfadenektomii. Oceniono także skuteczność i bezpieczeństwo pankreatoduodenektomii sposobem Whipple'a w porównaniu z zabiegiem oszczę-dzającym odźwiernik oraz paliatywnymi zabiegami chirurgicznymi i endoskopowymi w nieresekcyjnym raku trzustki. AbstractThe practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. In the medical scientific hierarchy, meta-analyses and randomized controlled trials have the highest rank and their results are discussed as evidence-based medicine. We have collected all the randomized controlled trials in our clinical and research area: exocrine pancreatic cancer. We have used PubMed systematically with the key words: pancreatic cancer and randomized controlled trials, and from reading those articles we have found a few more. The present review is an attempt to make it easier for clinical pancreatologists to keep updated our knowledge about preoperative biliary stenting, techniques of pancreaticojejunostomy and extended lymphadenectomy. We also compared the results of studies concerning standard Whipple versus pylorus-preserving pancreatoduodenectomy, retrocolic or antecolic gastroenterostomy, as well as surgery versus stenting in laparoscopically unresectable pancreatic cancer. WstępW nowoczesnej medycynie podejmowanie decyzji klinicznych powinno być oparte na evidence-based medicine (EBM), czyli dowodach płynących z dużych, dobrze zaprojektowanych i przeprowadzonych badań klinicznych z randomizacją (randomized controlled trials -RCTs) [1]. W naukowej hierarchii ważności najwyższe mi...

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A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: A meta-analysis of 1909 patients

Cited by 81 publications

References 40 publications

Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials

Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Surgical treatment of pancreatic cancer – randomized controlled trials

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