Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial

Cancer Communications

article

Qing Lin¹  Shangyou Zheng¹  Xianjun Yu⁴  Meifu Chen⁵  Yu Zhou¹  Quanbo Zhou²  Chonghui Hu¹  Jing Gu⁶  Zhongdong Xu³  Lin Wang³  Yimin Liu³  Qingyu Liu³  Min Wang^1,11  Guolin Li^1,12  He Cheng⁴  Dongkai Zhou^1,13  Guodong Liu^1,14  Zhiqiang Fu²  Yu Long²  Yixiong Li^1,14  Weilin Wang^1,13  Renyi Qin^1,11  Zhihua Li³  Rufu Chen¹ 

[1] Department of Pancreas Center, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences;Department of Pancreatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University;Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University;Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center;Hunan Research Center of Biliary Disease/Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University;Department of Medical Statistics, School of Public Health, Sun Yat-sen University;Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University;Department of Pathology, Sun Yat-sen Memorial Hospital;Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University Guangzhou;Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University;Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology;Department of Hepatobiliary, Pancreatic and Splenic surgery, the Sixth Affiliated Hospital of Sun Yat-sen University;Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University;Department of General Surgery, Xiangya Hospital, Central South University;Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine;Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province

关键词: disease-free survival;    extended;    lymph nodes;    nerve resection;    overall survival;    pancreatic head cancer;    pancreatoduodenectomy;    standard;   

DOI  :  10.1002/cac2.12399

学科分类：社会科学、人文和艺术（综合）

来源: Springer

【 摘 要 】

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.

【 授权许可】

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