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
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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DOI：
10.1097/sla.0000000000000384
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发表时间：
2014-04-01
影响因子：
9
通讯作者：
Kim, Sun-Whe
中科院分区：
文献类型：
--
作者：
Jang, Jin-Young;Kang, Mee Joo;Kim, Sun-Whe
目的：为了前瞻性地评估胰腺头癌患者神经丛和淋巴结清扫术的生存益处，尽管有关于胰腺癌手术范围的随机对照试验，但已经尝试进行更多的扩大切除术。其中200例随机接受标准切除术或扩大切除术，后者包括清除额外的淋巴结和上级肠系膜动脉和腹腔轴周围的右半部分神经丛。我们评估了来自7个中心的167例患者，他们符合所有要求的criteria.Result：手术时间较长，估计失血量在扩大切除组高于标准切除组，但R 0切除率相当。扩大切除组每例患者取出的平均淋巴结数量高于标准切除组（33.7 vs 17.3; P < 0.001）。扩大切除组的发病率略高于标准切除组。扩大切除组有2例患者在医院死亡。无论是否有淋巴结转移，扩大切除组和标准切除组R 0切除后的中位生存期相似（18.0 vs 19.0个月; P = 0.239）。辅助放化疗对总生存率有积极影响。结论：这项研究表明，扩大淋巴结切除术与神经丛的剥离并没有提供一个显着的生存优势相比，标准切除胰头癌。与扩大胰十二指肠切除术相比，标准切除术可以安全有效地进行，而不会对肿瘤疗效或长期生存产生负面影响。（NCT 00679913）？
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)?