Jin-Young Jang1, Jae Seung Kang1, Youngmin Han1, Jin Seok Heo2, Seong Ho Choi2, Dong Wook Choi2, Sang Jae Park3, Sung-Sik Han3, Dong Sup Yoon4, Joon Seong Park4, Hee Chul Yu5, Koo Jeong Kang6, Sang Geol Kim7, Hongeun Lee1, Wooil Kwon1, Yoo-Seok Yoon8, Ho-Seong Han8, Sun-Whe Kim1. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Center for Liver Cancer, National Cancer Center, Goyang, Korea. 4. Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 5. Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea. 6. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. 7. Department of Surgery, Kyungpook National University College of Medicine, Daegu, Korea. 8. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Abstract
BACKGROUND: Our previous randomized controlled trial revealed no difference in 2-year overall survival (OS) between extended and standard resection for pancreatic adenocarcinoma. The present study evaluated the 5-year OS and recurrence patterns according to the extent of pancreatectomy. METHODS:Between 2006 and 2009, 169 consecutive patients were prospectively enrolled and randomized to standard (n = 83) or extended resection (n = 86) groups to compare 5-year OS rate, long-term recurrence patterns and factors associated with long-term survival. RESULTS: The surgical R0 rate was similar between the standard and extended groups (85.5 vs. 90.7%, P = 0.300). Five-year OS (18.4 vs. 14.4%, P = 0.388), 5-year disease-free survival (14.8 vs. 14.0%, P = 0.531), and overall recurrence rates (74.7 vs. 69.9%, P = 0.497) were not significantly different between the two groups, although the incidence of peritoneal seeding was higher in the extended group (25 vs. 8.1%, P = 0.014). CONCLUSIONS: Extended pancreatectomy does not have better short-term and long-term survival outcomes, and shows similar R0 rates and overall recurrence rates compared with standard pancreatectomy. Extended pancreatectomy does not have to be performed routinely for all cases of resectable pancreatic adenocarcinoma, especially considering its associated increased morbidity shown in our previous study.
RCT Entities:
BACKGROUND: Our previous randomized controlled trial revealed no difference in 2-year overall survival (OS) between extended and standard resection for pancreatic adenocarcinoma. The present study evaluated the 5-year OS and recurrence patterns according to the extent of pancreatectomy. METHODS: Between 2006 and 2009, 169 consecutive patients were prospectively enrolled and randomized to standard (n = 83) or extended resection (n = 86) groups to compare 5-year OS rate, long-term recurrence patterns and factors associated with long-term survival. RESULTS: The surgical R0 rate was similar between the standard and extended groups (85.5 vs. 90.7%, P = 0.300). Five-year OS (18.4 vs. 14.4%, P = 0.388), 5-year disease-free survival (14.8 vs. 14.0%, P = 0.531), and overall recurrence rates (74.7 vs. 69.9%, P = 0.497) were not significantly different between the two groups, although the incidence of peritoneal seeding was higher in the extended group (25 vs. 8.1%, P = 0.014). CONCLUSIONS: Extended pancreatectomy does not have better short-term and long-term survival outcomes, and shows similar R0 rates and overall recurrence rates compared with standard pancreatectomy. Extended pancreatectomy does not have to be performed routinely for all cases of resectable pancreatic adenocarcinoma, especially considering its associated increased morbidity shown in our previous study.
Authors: William H Jin; Sarah E Hoffe; Ravi Shridhar; Tobin Strom; Puja Venkat; Gregory M Springett; Pamela J Hodul; Jose M Pimiento; Kenneth L Meredith; Mokenge P Malafa; Jessica M Frakes Journal: J Gastrointest Oncol Date: 2018-06
Authors: Ralph F Staerkle; Raphael Nicolas Vuille-Dit-Bille; Christopher Soll; Rebekka Troller; Jaswinder Samra; Milo A Puhan; Stefan Breitenstein Journal: Cochrane Database Syst Rev Date: 2021-01-20