Although some retrospective studies of extended radical lymphadenectomy for pancreatic cancer have suggested a survival advantage, this is controversial.
Dr Michalski and colleagues conducted a literature search of randomized controlled trials comparing extended with standard lymphadenectomy in pancreatic cancer surgery.
Overall survival was analyzed using hazard ratios and standard errors.
Pooled estimates of overall treatment effects were calculated using a random effects model.
|The weighted mean log hazard ratio for survival overall was 0.9|
|British Journal of Surgery|
The researchers identified 4 randomized trials for systematic review, 3 were included in a meta-analysis of survival.
The log hazard ratios for survival for the three trials were 0.4, and -0.2, and - 0.2.
The researchers noted no significant differences between the standard and extended procedure.
The team found that the weighted mean log hazard ratio for survival overall was 0.9.
Morbidity and mortality rates were also comparable, with a trend towards higher rates of delayed gastric emptying for extended lymphadenectomy.
The researchers observed that the number of resected lymph nodes was significantly higher in the extended lymphadenectomy groups.
Dr Michalski's team concluded, “The extended procedure does not benefit overall survival, and there may even be a trend towards increased morbidity.”
“Therefore extended lymphadenectomy should be performed only within adequately powered controlled trials, if at all.”