Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial
Abstract Background The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial, and more high‐level clinical evidence is needed. This study aimed to evaluate the outcome of extended pancreatoduodenectomy (EPD) with retroperitoneal nerve resection in pancreatic head cancer....
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Cancer Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cac2.12399 |
| _version_ | 1828033537734868992 |
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| author | Qing Lin Shangyou Zheng Xianjun Yu Meifu Chen Yu Zhou Quanbo Zhou Chonghui Hu Jing Gu Zhongdong Xu Lin Wang Yimin Liu Qingyu Liu Min Wang Guolin Li He Cheng Dongkai Zhou Guodong Liu Zhiqiang Fu Yu Long Yixiong Li Weilin Wang Renyi Qin Zhihua Li Rufu Chen |
| author_facet | Qing Lin Shangyou Zheng Xianjun Yu Meifu Chen Yu Zhou Quanbo Zhou Chonghui Hu Jing Gu Zhongdong Xu Lin Wang Yimin Liu Qingyu Liu Min Wang Guolin Li He Cheng Dongkai Zhou Guodong Liu Zhiqiang Fu Yu Long Yixiong Li Weilin Wang Renyi Qin Zhihua Li Rufu Chen |
| author_sort | Qing Lin |
| collection | DOAJ |
| description | Abstract Background The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial, and more high‐level clinical evidence is needed. This study aimed to evaluate the outcome of extended pancreatoduodenectomy (EPD) with retroperitoneal nerve resection in pancreatic head cancer. Methods This multicenter randomized trial was performed at 6 Chinese high‐volume hospitals that enrolled patients between October 3, 2012, and September 21, 2017. Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments (preoperative chemotherapy or chemoradiation) within three months were randomly assigned to undergo standard pancreatoduodenectomy (SPD) or EPD, with the latter followed by dissection of additional lymph nodes (LNs), nerves and soft tissues 270° on the right side surrounding the superior mesenteric artery and celiac axis. The primary endpoint was overall survival (OS) by intention‐to‐treat (ITT). The secondary endpoints were disease‐free survival (DFS), mortality, morbidity, and postoperative pain intensity. Results The R1 rate was slightly lower with EPD (8.46%) than with SPD (12.56%). The morbidity and mortality rates were similar between the two groups. The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort (23.0 vs. 20.2 months, P = 0.100), while the median DFS was superior in the EPD group (16.1 vs. 13.2 months, P = 0.031). Patients with preoperative CA19–9 < 200.0 U/mL had significantly improved OS and DFS with EPD (EPD vs. SPD, 30.8 vs. 20.9 months, P = 0.009; 23.4 vs. 13.5 months, P < 0.001). The EPD group exhibited significantly lower locoregional (16.48% vs. 35.20%, P < 0.001) and mesenteric LN recurrence rates (3.98% vs. 10.06%, P = 0.022). The EPD group exhibited less back pain 6 months postoperation than the SPD group. Conclusions EPD for pancreatic head cancer did not significantly improve OS, but patients with EPD treatment had significantly improved DFS. In the subgroup analysis, improvements in both OS and DFS in the EPD arm were observed in patients with preoperative CA19–9 < 200.0 U/mL. EPD could be used as an effective surgical procedure for patients with pancreatic head cancer, especially those with preoperative CA19–9 < 200.0 U/mL. |
| first_indexed | 2024-04-10T15:21:08Z |
| format | Article |
| id | doaj.art-098f382bbbeb4a19942ee6f1dd4d96c3 |
| institution | Directory Open Access Journal |
| issn | 2523-3548 |
| language | English |
| last_indexed | 2024-04-10T15:21:08Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Communications |
| spelling | doaj.art-098f382bbbeb4a19942ee6f1dd4d96c32023-02-14T14:04:52ZengWileyCancer Communications2523-35482023-02-0143225727510.1002/cac2.12399Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trialQing Lin0Shangyou Zheng1Xianjun Yu2Meifu Chen3Yu Zhou4Quanbo Zhou5Chonghui Hu6Jing Gu7Zhongdong Xu8Lin Wang9Yimin Liu10Qingyu Liu11Min Wang12Guolin Li13He Cheng14Dongkai Zhou15Guodong Liu16Zhiqiang Fu17Yu Long18Yixiong Li19Weilin Wang20Renyi Qin21Zhihua Li22Rufu Chen23Department of Pancreas Center Department of General Surgery Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreas Center Department of General Surgery Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreatic Surgery Fudan University Shanghai Cancer Center Shanghai People's Republic of ChinaHunan Research Center of Biliary Disease/Department of Hepatobiliary Surgery Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University Changsha Hunan People's Republic of ChinaDepartment of Pancreas Center Department of General Surgery Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreatobiliary Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreas Center Department of General Surgery Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong People's Republic of ChinaDepartment of Medical Statistics School of Public Health Sun Yat‐sen University Guangzhou Guangdong People's Republic of ChinaGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat‐Sen Memorial Hospital Sun Yat‐Sen University Guangzhou Guangdong People's Republic of ChinaGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat‐Sen Memorial Hospital Sun Yat‐Sen University Guangzhou Guangdong People's Republic of ChinaGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat‐Sen Memorial Hospital Sun Yat‐Sen University Guangzhou Guangdong People's Republic of ChinaGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat‐Sen Memorial Hospital Sun Yat‐Sen University Guangzhou Guangdong People's Republic of ChinaDepartment of Biliary‐Pancreatic Surgery Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei People's Republic of ChinaDepartment of Hepatobiliary Pancreatic and Splenic surgery the Sixth Affiliated Hospital of Sun Yat‐sen University Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreatic Surgery Fudan University Shanghai Cancer Center Shanghai People's Republic of ChinaHepatobiliary and Pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic Surgery The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang People's Republic of ChinaDepartment of General Surgery Xiangya Hospital Central South University Changsha Hunan People's Republic of ChinaDepartment of Pancreatobiliary Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreatobiliary Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou Guangdong People's Republic of ChinaDepartment of General Surgery Xiangya Hospital Central South University Changsha Hunan People's Republic of ChinaHepatobiliary and Pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic Surgery The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang People's Republic of ChinaDepartment of Biliary‐Pancreatic Surgery Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei People's Republic of ChinaGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat‐Sen Memorial Hospital Sun Yat‐Sen University Guangzhou Guangdong People's Republic of ChinaDepartment of Pancreas Center Department of General Surgery Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong People's Republic of ChinaAbstract Background The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial, and more high‐level clinical evidence is needed. This study aimed to evaluate the outcome of extended pancreatoduodenectomy (EPD) with retroperitoneal nerve resection in pancreatic head cancer. Methods This multicenter randomized trial was performed at 6 Chinese high‐volume hospitals that enrolled patients between October 3, 2012, and September 21, 2017. Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments (preoperative chemotherapy or chemoradiation) within three months were randomly assigned to undergo standard pancreatoduodenectomy (SPD) or EPD, with the latter followed by dissection of additional lymph nodes (LNs), nerves and soft tissues 270° on the right side surrounding the superior mesenteric artery and celiac axis. The primary endpoint was overall survival (OS) by intention‐to‐treat (ITT). The secondary endpoints were disease‐free survival (DFS), mortality, morbidity, and postoperative pain intensity. Results The R1 rate was slightly lower with EPD (8.46%) than with SPD (12.56%). The morbidity and mortality rates were similar between the two groups. The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort (23.0 vs. 20.2 months, P = 0.100), while the median DFS was superior in the EPD group (16.1 vs. 13.2 months, P = 0.031). Patients with preoperative CA19–9 < 200.0 U/mL had significantly improved OS and DFS with EPD (EPD vs. SPD, 30.8 vs. 20.9 months, P = 0.009; 23.4 vs. 13.5 months, P < 0.001). The EPD group exhibited significantly lower locoregional (16.48% vs. 35.20%, P < 0.001) and mesenteric LN recurrence rates (3.98% vs. 10.06%, P = 0.022). The EPD group exhibited less back pain 6 months postoperation than the SPD group. Conclusions EPD for pancreatic head cancer did not significantly improve OS, but patients with EPD treatment had significantly improved DFS. In the subgroup analysis, improvements in both OS and DFS in the EPD arm were observed in patients with preoperative CA19–9 < 200.0 U/mL. EPD could be used as an effective surgical procedure for patients with pancreatic head cancer, especially those with preoperative CA19–9 < 200.0 U/mL.https://doi.org/10.1002/cac2.12399disease‐free survivalextendedlymph nodesnerve resectionoverall survivalpancreatic head cancer |
| spellingShingle | Qing Lin Shangyou Zheng Xianjun Yu Meifu Chen Yu Zhou Quanbo Zhou Chonghui Hu Jing Gu Zhongdong Xu Lin Wang Yimin Liu Qingyu Liu Min Wang Guolin Li He Cheng Dongkai Zhou Guodong Liu Zhiqiang Fu Yu Long Yixiong Li Weilin Wang Renyi Qin Zhihua Li Rufu Chen Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial Cancer Communications disease‐free survival extended lymph nodes nerve resection overall survival pancreatic head cancer |
| title | Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial |
| title_full | Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial |
| title_fullStr | Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial |
| title_full_unstemmed | Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial |
| title_short | Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial |
| title_sort | standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer a multicenter randomized controlled trial |
| topic | disease‐free survival extended lymph nodes nerve resection overall survival pancreatic head cancer |
| url | https://doi.org/10.1002/cac2.12399 |
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