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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

Jang, Jin-Young MD, PhD*; Kang, Mee Joo MD, PhD*; Heo, Jin Seok MD, PhD; Choi, Seong Ho MD, PhD; Choi, Dong Wook MD, PhD; Park, Sang Jae MD, PhD; Han, Sung-Sik MD, PhD; Yoon, Dong Sup MD, PhD§; Yu, Hee Chul MD, PhD; Kang, Koo Jeong MD, PhD; Kim, Sang Geol MD, PhD**; Kim, Sun-Whe MD, PhD, FACS*

Annals of Surgery:
doi: 10.1097/SLA.0000000000000384
Randomized Controlled Trials
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 affecting oncologic efficacy or long-term survival, when compared with extended pancreaticoduodenal resection. (NCT00679913)?

In Brief

This randomized controlled trial suggests that extended lymphadenectomy with dissection of the nerve plexus does not provide significant survival benefit compared with standard resection in patients with pancreatic head cancer. Standard resection can be performed safely and efficiently, without negatively affecting oncologic efficacy or long-term survival, compared with extended pancreaticoduodenal resection.

Author Information

*Department of Surgery, Seoul National University College of Medicine, Seoul

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul

Center for Liver Cancer, National Cancer Center, Gyeonggido

§Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul

Department of Surgery, Chonbuk National University Medical School, Jeonbuk

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu; and

**Department of Surgery, Kyungpook National University College of Medicine, Daegu.

Reprints: Sun-Whe Kim, MD, PhD, FACS, Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail: sunkim@plaza.snu.ac.kr.

Disclosure: Supported by the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (grant nos. 0820030 and 1120310). The authors declare no conflicts of interest.

The study sponsor had no involvement in trial design, collection, analysis, interpretation of data, or writing this report. The corresponding author had full access to all data and had final responsibility for the decision to submit the report for publication.

© 2014 by Lippincott Williams & Wilkins.