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A Prospective Randomized Controlled Study Comparing Outcomes of Standard Resection and Extended Resection, Including Dissection of the Nerve Plexus and Various Lymph Nodes, in Patients With Pancreatic Head Cancer

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Author(s)
강구정
Alternative Author(s)
Kang, Koo Jeong
Publication Year
2014
Abstract
Objective: To prospectively evaluate the survival benefit of dissection of the
nerve plexus and lymphadenectomy in patients with pancreatic head cancer.
Background: Despite randomized controlled trials on the extent of surgery
in pancreatic cancer, attempts have been made to perform more extended
resections.
Methods: A total of 244 patients were enrolled; of these, 200 were randomized
to undergo standard resection or extended resection, with the latter
including the dissection of additional lymph nodes and the right half
of the nerve plexus around the superior mesenteric artery and celiac axis.
We evaluated 167 patients from 7 centers who fulfilled all of the required
criteria.
Result: Operation time was longer and estimated blood loss was higher in
the extended resection group than in the standard resection group, but the
R0 resection rate was comparable. The mean number of lymph nodes retrieved
per patient was higher in the extended resection group than in the
standard resection group (33.7 vs 17.3; P < 0.001). The morbidity rate was
slightly higher in the extended resection group than in the standard resection
group. Two patients in the extended resection group died in hospital. Median
survival after R0 resection was similar in the extended resection and standard
resection groups (18.0 vs 19.0 months; P = 0.239) regardless of lymph
node metastasis. Adjuvant chemoradiation had a positive impact on overall
survival.
Conclusions: This study suggests that extended lymphadenectomy with dissection
of the nerve plexus does not provide a significant survival benefit
compared with standard resection in pancreatic head cancer. Standard resection
can be performed safely and efficiently, without negatively affectingoncologic efficacy or long-term survival, when compared with extended pancreaticoduodenal
resection. (NCT00679913)?
Keywords: cancer, lymph node, nerve, pancreas, survival analysis
(Ann Surg 2014;259:656–664)
Department
Dept. of Surgery (외과학)
Publisher
School of Medicine
Citation
Annals of Surgery, Vol.259(4) : 656-663, 2014
Type
Article
ISSN
0003-4932
DOI
10.1097/SLA.0000000000000384
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/35038
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