Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy

Arch Surg. 2003 Dec;138(12):1316-22. doi: 10.1001/archsurg.138.12.1316.


Hypothesis: An aggressive strategy that includes extended lymphadenectomy and vein resection may improve the results of surgical treatment of pancreatic head cancer.

Design: Nonrandomized control trial.

Setting: Tertiary care referral center.

Patients: The study included 149 consecutive patients undergoing macroscopically curative resection for periampullary adenocarcinoma from January 1, 1988, to December 31, 1998.

Interventions: A standard resection was performed in 122 cases; an extended lymphadenectomy in 37. Twenty-four patients underwent venous resection.

Main outcome measures: Data on surgical mortality, morbidity, and postoperative outcome, pathological findings, and long-term survival were analyzed.

Results: In-hospital and 60-day operative mortality was 5.4%. Morbidity was 37.5%. Mortality, morbidity, and postoperative stay were nonsignificantly modified by extended lymphadenectomy or venous resection. Extended resection permitted the identification of a significantly higher percentage of nodal metastases beyond the peripancreatic node groups. In patients undergoing vein resection, a significantly higher rate of positive retroperitoneal margin was found. In the 100 patients with ductal adenocarcinoma, the median overall survival and the 5-year actuarial survival rate were 15 months and 8.4%, respectively. A trend toward a better survival was observed in the first 2 years after operation in the extended resection group compared with the standard resection group. Nodal status was the most powerful predictor of overall survival by multivariate analysis.

Conclusions: Extended lymphadenectomy and vein resection did not adversely affect postoperative mortality and morbidity. Patients who required a vein resection were less likely to receive a microscopically curative pancreatectomy. Extended resection permitted better pathological staging and was associated with an early advantage in survival, but long-term survival was possible only in patients with favorable prognostic factors.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adenocarcinoma / surgery*
  • Female
  • Hospital Mortality
  • Humans
  • Lymph Node Excision*
  • Male
  • Mesenteric Veins / surgery
  • Neoplasm Staging
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / methods
  • Portal Vein / surgery
  • Postoperative Complications
  • Proportional Hazards Models
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome