Abstract
Aim
To compare outcomes between pancreaticoduodenectomy (PD) and extended pancreaticoduodenectomy
(EPD) from all published comparative studies in the literature.
Methods
Using meta-analytical techniques the present study compared operative details, post-operative
adverse events and survival following PD and EPD. Comparative studies published between
1988 and 2005 of PD versus EPD were included. End points were classified into peri-operative
details, post-operative complications including 30 day mortality, and survival as measured during follow up. A random effect model was
employed.
Results
Sixteen comparative studies comprising 1909 patients (865 PD and 1044 EPD), including
3 randomized controlled trials with 454 patients (226 PD and 228 EPD) were identified.
Tumour size was comparable between the groups (weighted mean difference (WMD) −0.16 cm, p = 0.76). Significantly more lymph nodes were harvested from those patients undergoing
EPD (WMD p = 14 nodes, p ≤ 0.001). Operative time was longer in EPD (WMD −48.9 min, p < 0.001) and there was a trend towards fewer positive resection margins (odds ratio
(OR) 1.78, p = 0.080). Peri-operative adverse events were similar between the groups with only delayed
gastric emptying (OR 0.59, p = 0.030) occurring less frequently in the PD group. Peri-operative mortality (OR 1.48,
p = 0.180) and long-term survival (hazard ratio 0.77, p = 0.100) showed a non-significant trend favouring EPD.
Conclusions
EPD is associated with a greater nodal harvest and fewer positive resection margins
than PD. However, the risk of delayed gastric emptying is increased and no significant
survival benefit has been shown. Better designed, adequately powered studies are required
to settle this question.
Keywords
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Article info
Publication history
Accepted:
January 8,
2008
Footnotes
☆This work was presented in part in the Young Investigator Award session at 7th World Congress of International Hepato-Pancreato-Biliary Association on 5 September 2006 in Edinburgh, Scotland and abstracted as HPB 2006;8(suppl 2):5.
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
