Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis
BackgroundPancreatic cancer has a poor prognosis, and surgical resection is the only curative option. Extended lymphadenectomy (EPD) during pancreatoduodenectomy may improve staging and reduce recurrence, but its survival benefits over standard lymphadenectomy (SPD) remain controversial.MethodsA sys...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1622966/full |
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| author | Yu-Chun Xu Yin-Hao Shi Xiao-Feng Li |
| author_facet | Yu-Chun Xu Yin-Hao Shi Xiao-Feng Li |
| author_sort | Yu-Chun Xu |
| collection | DOAJ |
| description | BackgroundPancreatic cancer has a poor prognosis, and surgical resection is the only curative option. Extended lymphadenectomy (EPD) during pancreatoduodenectomy may improve staging and reduce recurrence, but its survival benefits over standard lymphadenectomy (SPD) remain controversial.MethodsA systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted on March 25, 2025. All studies that met the inclusion criteria were subjected to quality assessment and subsequently analyzed by meta-analytical methods.ResultsNine RCTs involving 1382 patients were analyzed. No significant differences were observed between EPD and SPD in OS (HR = 1.09, p = 0.384), DFS (HR = 1.08, p = 0.506), or recurrence (78.05% vs. 79.64%, p = 0.295). EPD retrieved more positive lymph nodes (MD = 0.66, p = 0.008), but did not improve prognosis. Postoperative morbidity (38.49% vs. 33.27%, p = 0.072), mortality (1.97% vs. 1.33%, p = 0.589), transfusion volume (MD = -31.27, p = 0.469), and hospital stay (MD = -0.15, p = 0.917) were comparable, though EPD increased operative time (MD = 53.24, p < 0.001).ConclusionsEPD reduces lymph node recurrence without improving OS or DFS, suggesting limited prognostic benefit. Its application in pancreatic cancer should be carefully considered.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42024594566. |
| format | Article |
| id | doaj-art-1ea89a7e8ab04d4b8c0810ceadaa65a9 |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-1ea89a7e8ab04d4b8c0810ceadaa65a92025-08-20T02:35:34ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-06-011510.3389/fonc.2025.16229661622966Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysisYu-Chun Xu0Yin-Hao Shi1Xiao-Feng Li2Department of Gastroenterology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaDepartment of Hepatobiliary Surgery and Liver Transplantation, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaDepartment of Gastroenterology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaBackgroundPancreatic cancer has a poor prognosis, and surgical resection is the only curative option. Extended lymphadenectomy (EPD) during pancreatoduodenectomy may improve staging and reduce recurrence, but its survival benefits over standard lymphadenectomy (SPD) remain controversial.MethodsA systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted on March 25, 2025. All studies that met the inclusion criteria were subjected to quality assessment and subsequently analyzed by meta-analytical methods.ResultsNine RCTs involving 1382 patients were analyzed. No significant differences were observed between EPD and SPD in OS (HR = 1.09, p = 0.384), DFS (HR = 1.08, p = 0.506), or recurrence (78.05% vs. 79.64%, p = 0.295). EPD retrieved more positive lymph nodes (MD = 0.66, p = 0.008), but did not improve prognosis. Postoperative morbidity (38.49% vs. 33.27%, p = 0.072), mortality (1.97% vs. 1.33%, p = 0.589), transfusion volume (MD = -31.27, p = 0.469), and hospital stay (MD = -0.15, p = 0.917) were comparable, though EPD increased operative time (MD = 53.24, p < 0.001).ConclusionsEPD reduces lymph node recurrence without improving OS or DFS, suggesting limited prognostic benefit. Its application in pancreatic cancer should be carefully considered.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42024594566.https://www.frontiersin.org/articles/10.3389/fonc.2025.1622966/fullpancreatic cancerlymphadenectomyprognosiscomplicationsmeta-analysis |
| spellingShingle | Yu-Chun Xu Yin-Hao Shi Xiao-Feng Li Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis Frontiers in Oncology pancreatic cancer lymphadenectomy prognosis complications meta-analysis |
| title | Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis |
| title_full | Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis |
| title_fullStr | Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis |
| title_full_unstemmed | Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis |
| title_short | Outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer: systematic review and meta-analysis |
| title_sort | outcomes of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic cancer systematic review and meta analysis |
| topic | pancreatic cancer lymphadenectomy prognosis complications meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1622966/full |
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