Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials
Introduction 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)....
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2015-09, Vol.19 (9), p.1725-1732 |
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| creator | Dasari, Bobby V M Pasquali, Sandro Vohra, Ravinder S Smith, Andrew M Taylor, Mark A Sutcliffe, Robert P Muiesan, Paolo Roberts, Keith J Isaac, John Mirza, Darius F |
| description | Introduction
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
|
| doi_str_mv | 10.1007/s11605-015-2859-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1705476455</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1705476455</sourcerecordid><originalsourceid>FETCH-LOGICAL-c508t-c771319602282808ff2ea9d06d5de4020304b149d5550ae7f5ea78e51aa9e6623</originalsourceid><addsrcrecordid>eNp1kVFrFTEQhYNYbG39Ab5IwBdfUifZnSTrW7lUW7hS0VZ8C-lmVrfsbm6TXej115t6axHBp5kh3zlD5jD2UsKxBDBvs5QaUIBEoSw2onrCDqQ1lai10k9LD40UCvHbPnue8w2ANCDtM7avigxlhQcsnd7NNAUK_CulvGT-ZfZT8Cnw9Xbc_PCBJmrnOG55FxP_5Kc2kZ_7lp-RD3xVZkrv-EeavTiZ_LDNfeax45-LSRz7n8V3Fac5xWEo7WXq_ZCP2F5XCr14qIfs6v3p5epMrC8-nK9O1qJFsLNojZGVbDQoZZUF23WKfBNABwxUg4IK6mtZNwERwZPpkLyxhNL7hrRW1SF7s_PdpHi7UJ7d2OeWhsFPFJfsyjGwNrpGLOjrf9CbuKTyn99UXRtTWV0ouaPaFHNO1LlN6keftk6Cuw_E7QJxJRB3H4iriubVg_NyPVJ4VPxJoABqB-TyNH2n9Nfq_7r-AkAMlVA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1704477386</pqid></control><display><type>article</type><title>Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Dasari, Bobby V M ; Pasquali, Sandro ; Vohra, Ravinder S ; Smith, Andrew M ; Taylor, Mark A ; Sutcliffe, Robert P ; Muiesan, Paolo ; Roberts, Keith J ; Isaac, John ; Mirza, Darius F</creator><creatorcontrib>Dasari, Bobby V M ; Pasquali, Sandro ; Vohra, Ravinder S ; Smith, Andrew M ; Taylor, Mark A ; Sutcliffe, Robert P ; Muiesan, Paolo ; Roberts, Keith J ; Isaac, John ; Mirza, Darius F</creatorcontrib><description>Introduction
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 %).
Conclusion
SPD is associated with reduced morbidity, but equivalent long-term benefits compared to patients undergoing EPD.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-015-2859-3</identifier><identifier>PMID: 26055135</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Carcinoma - mortality ; Carcinoma - pathology ; Carcinoma - surgery ; Clinical trials ; Gastroenterology ; Humans ; Length of stay ; Lymph Node Excision ; Lymphatic system ; Medical prognosis ; Medicine ; Medicine & Public Health ; Meta-analysis ; Metastasis ; Morbidity ; Mortality ; Pancreatic cancer ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Prognosis ; Randomized Controlled Trials as Topic ; Review Article ; Surgery ; Survival analysis ; Systematic review ; Veins & arteries</subject><ispartof>Journal of gastrointestinal surgery, 2015-09, Vol.19 (9), p.1725-1732</ispartof><rights>The Society for Surgery of the Alimentary Tract 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-c771319602282808ff2ea9d06d5de4020304b149d5550ae7f5ea78e51aa9e6623</citedby><cites>FETCH-LOGICAL-c508t-c771319602282808ff2ea9d06d5de4020304b149d5550ae7f5ea78e51aa9e6623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-015-2859-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-015-2859-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26055135$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dasari, Bobby V M</creatorcontrib><creatorcontrib>Pasquali, Sandro</creatorcontrib><creatorcontrib>Vohra, Ravinder S</creatorcontrib><creatorcontrib>Smith, Andrew M</creatorcontrib><creatorcontrib>Taylor, Mark A</creatorcontrib><creatorcontrib>Sutcliffe, Robert P</creatorcontrib><creatorcontrib>Muiesan, Paolo</creatorcontrib><creatorcontrib>Roberts, Keith J</creatorcontrib><creatorcontrib>Isaac, John</creatorcontrib><creatorcontrib>Mirza, Darius F</creatorcontrib><title>Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Introduction
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 %).
Conclusion
SPD is associated with reduced morbidity, but equivalent long-term benefits compared to patients undergoing EPD.</description><subject>Carcinoma - mortality</subject><subject>Carcinoma - pathology</subject><subject>Carcinoma - surgery</subject><subject>Clinical trials</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Length of stay</subject><subject>Lymph Node Excision</subject><subject>Lymphatic system</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Metastasis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Prognosis</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Review Article</subject><subject>Surgery</subject><subject>Survival analysis</subject><subject>Systematic review</subject><subject>Veins & arteries</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kVFrFTEQhYNYbG39Ab5IwBdfUifZnSTrW7lUW7hS0VZ8C-lmVrfsbm6TXej115t6axHBp5kh3zlD5jD2UsKxBDBvs5QaUIBEoSw2onrCDqQ1lai10k9LD40UCvHbPnue8w2ANCDtM7avigxlhQcsnd7NNAUK_CulvGT-ZfZT8Cnw9Xbc_PCBJmrnOG55FxP_5Kc2kZ_7lp-RD3xVZkrv-EeavTiZ_LDNfeax45-LSRz7n8V3Fac5xWEo7WXq_ZCP2F5XCr14qIfs6v3p5epMrC8-nK9O1qJFsLNojZGVbDQoZZUF23WKfBNABwxUg4IK6mtZNwERwZPpkLyxhNL7hrRW1SF7s_PdpHi7UJ7d2OeWhsFPFJfsyjGwNrpGLOjrf9CbuKTyn99UXRtTWV0ouaPaFHNO1LlN6keftk6Cuw_E7QJxJRB3H4iriubVg_NyPVJ4VPxJoABqB-TyNH2n9Nfq_7r-AkAMlVA</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Dasari, Bobby V M</creator><creator>Pasquali, Sandro</creator><creator>Vohra, Ravinder S</creator><creator>Smith, Andrew M</creator><creator>Taylor, Mark A</creator><creator>Sutcliffe, Robert P</creator><creator>Muiesan, Paolo</creator><creator>Roberts, Keith J</creator><creator>Isaac, John</creator><creator>Mirza, Darius F</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials</title><author>Dasari, Bobby V M ; Pasquali, Sandro ; Vohra, Ravinder S ; Smith, Andrew M ; Taylor, Mark A ; Sutcliffe, Robert P ; Muiesan, Paolo ; Roberts, Keith J ; Isaac, John ; Mirza, Darius F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-c771319602282808ff2ea9d06d5de4020304b149d5550ae7f5ea78e51aa9e6623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Carcinoma - mortality</topic><topic>Carcinoma - pathology</topic><topic>Carcinoma - surgery</topic><topic>Clinical trials</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Length of stay</topic><topic>Lymph Node Excision</topic><topic>Lymphatic system</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Metastasis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Prognosis</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Review Article</topic><topic>Surgery</topic><topic>Survival analysis</topic><topic>Systematic review</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dasari, Bobby V M</creatorcontrib><creatorcontrib>Pasquali, Sandro</creatorcontrib><creatorcontrib>Vohra, Ravinder S</creatorcontrib><creatorcontrib>Smith, Andrew M</creatorcontrib><creatorcontrib>Taylor, Mark A</creatorcontrib><creatorcontrib>Sutcliffe, Robert P</creatorcontrib><creatorcontrib>Muiesan, Paolo</creatorcontrib><creatorcontrib>Roberts, Keith J</creatorcontrib><creatorcontrib>Isaac, John</creatorcontrib><creatorcontrib>Mirza, Darius F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dasari, Bobby V M</au><au>Pasquali, Sandro</au><au>Vohra, Ravinder S</au><au>Smith, Andrew M</au><au>Taylor, Mark A</au><au>Sutcliffe, Robert P</au><au>Muiesan, Paolo</au><au>Roberts, Keith J</au><au>Isaac, John</au><au>Mirza, Darius F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>19</volume><issue>9</issue><spage>1725</spage><epage>1732</epage><pages>1725-1732</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Introduction
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 %).
Conclusion
SPD is associated with reduced morbidity, but equivalent long-term benefits compared to patients undergoing EPD.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26055135</pmid><doi>10.1007/s11605-015-2859-3</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2015-09, Vol.19 (9), p.1725-1732 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1705476455 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Carcinoma - mortality Carcinoma - pathology Carcinoma - surgery Clinical trials Gastroenterology Humans Length of stay Lymph Node Excision Lymphatic system Medical prognosis Medicine Medicine & Public Health Meta-analysis Metastasis Morbidity Mortality Pancreatic cancer Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Prognosis Randomized Controlled Trials as Topic Review Article Surgery Survival analysis Systematic review Veins & arteries |
| title | Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials |
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