Journal du pancréas Libre accès

Abstrait

Extended Lymph Node Dissection in Pancreaticoduodenenctomy? A Case-control Study

Dionysios Dellaportas, Nikolaos Arkadopoulos, Panagis Michael Lykoudis, Despoina Myoteri, Amanda Psyrri, Pantelis Vassiliu, Panagiotis Athanasopoulos, Andreas Polydorou, Ioannis Vassiliou, Vassilios Smyrniotis

Context/Objective The aim of this study was to evaluate the effect of extended lymphadenectomy in a subgroup of patients with early stage periampullary cancer. Methods From January 2005 until December 2010, 152 consecutive patients underwent pancreaticoduodenectomy in a single institution for periampullary adenocarcinoma. Half of these patients were subjected to standard pancreaticoduodenectomy, and comprised the control group of this study while the other half underwent an extended lymph node dissection approach. The subjects of each group were divided in two subgroups according to the size of the primary tumor, with a cutoff of 2 cm. Results There were no significant differences in age (median age 61 and 62 in two groups respectively) and gender distribution (65.8% versus 60.6% male) among study groups, nor in the primary tumor size (median size 3.15 and 3.11 in two groups respectively). All patients underwent a pylorus preserving standard or extended lymph node dissection pancreaticoduodenectomy. The median operative time (207 minutes for standard pancreaticoduodenectomy group versus 258 minutes for extended lymph node dissection group, p=0.035), blood loss (520 mL for standard pancreaticoduodenectomy versus 720 ml for extended lymph node dissection group, p=0.04), overall postoperative hospital stay (11 versus 16 days respectively, p=0.02) were significantly lower in the standard pancreaticoduodenectomy patients. In addition, morbidity was significantly lower for the first group (32% vs. 44%, p=0.02). There was no significant survival difference between the two groups. Conclusions Pancreaticoduodenectomy is a major surgical procedure and despite improvements in management and technical refinements, there is no evidence for modification of the operation towards increased lymph node harvesting.