Extended vs standard lymphadenectomy in patients of pancreatic head adenocarcinoma undergoing pancreatoduodenectomy: A systematic review and updated meta-analysis.

Abstract

e16369 Background: Pancreatic Head Adenocarcinoma is treated by radical pancreaticoduodenenectomy, which also includes lymph node resection. Different RCTs have explored different approaches to it, and the extent of lymph node resection remains controversial. This meta-analysis compares the efficacy of Standard vs Extended Lymphadenectomy in the treatment of PHA. Methods: We comprehensively searched literature on MEDLINE, Embase, Google Scholar and Cochrane using MeSH terms and relevant keywords for “Pancreatic Head Adenocarcinoma” and “Lymphadenectomy” from inception to Nov, 2024, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both strategies for treatment of PHA. Random effects model was used to aggregate the risk ratios (RR) for dichotomous and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Results: The search strategy retrieved 2330 studies. Duplicates and irrelevant articles were removed and data from nine RCTs (1139 patients) was extracted. The mean age in SG was 63.65 and 61.9 in EG. ELNR was found better than SLNR in terms of OS at 1 year (RR 0.86, 95%CI 0.81-0.92,p = 0.00001, I² = 0%), OS at 3 years.(RR 0.85, 95%CI 0.70-1.01,p = 0.07, I² = 42%). Both the groups were comparable in post operative mortality(RR 1.22, 95%CI 0.53-2.81, I² = 0%). Operation time (RR 29.56, 95%CI 17.09-42.83,p = 0.00001, I² = 92%) was significantly more in the Standard group. However the high heterogeneity in OT may depend onthe surgeon's skill and methodology in performing the operation. Conclusions: ELNR showed better results in comparison to SLNR in OS at years 1 and 3.Post operative mortality showed comparative results, whereas operation time was significantly lengthened in SLNR.