Does lymph node ratio impact survival in resected periampullary malignancies? Am J Surg. 2009;197:348-352. [PMID: 19245913 DOI: org/10.1016/j.amjsurg.2008.11.010]

Standard vs extended lymphadenectomy associated with pancreaticoduodenectomy for periampullary adenocarcinoma: A meta-analysis

AIM: To review and evaluate the therapeutic efficacy of extended lymph node dissection (ELND) associated with pancreaticoduodenectomy for periampullary adenocarcinoma compared to conventional standard lymph node dissection (SLND).

METHODS: The Cochrane Library and Controlled Trials Registry (1991-2010), Medline Ovid (1956-2010), PubMed (1977-2010), Science Direct (1956-2010), and Web of Knowledge (1956-2010) were electronically searched for randomized clinical trials (RCTs) that compared the therapeutic endpoints of SLND vs ELND associated with pancreaticoduodenectomy for periampullary adenocarcinoma patients, with English language as a limit. Meta-analysis was performed using RevMan 5.0.22 software.

RESULTS: Five RCTs involving 673 patients were included for pooled analysis. Meta-analysis showed that ELND were associated with longer operative time and higher number of dissected lymph nodes than SLND. The postoperative morbidity and mortality were similar when the two groups were compared except a significant lower frequency of delayed gastric emptying in the SLND group. There was no significant difference between two groups regarding long-term survival.

CONCLUSION: ELND appears not to improve the long-term survival of patients with periampullary cancer although a significant higher number of lymph nodes dissected were observed in the ELND group.