Xu Yu-Chun, Shi Yin-Hao, Li Xiao-Feng
Department of Gastroenterology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Department of Hepatobiliary Surgery and Liver Transplantation, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Front Oncol. 2025 Jun 27;15:1622966. doi: 10.3389/fonc.2025.1622966. eCollection 2025.
Pancreatic cancer has a poor prognosis, and surgical resection is the only curative option. Extended lymphadenectomy (EPD) during pancreatoduodenectomy may improve staging and reduce recurrence, but its survival benefits over standard lymphadenectomy (SPD) remain controversial.
A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted on March 25, 2025. All studies that met the inclusion criteria were subjected to quality assessment and subsequently analyzed by meta-analytical methods.
Nine RCTs involving 1382 patients were analyzed. No significant differences were observed between EPD and SPD in OS (HR = 1.09, = 0.384), DFS (HR = 1.08, = 0.506), or recurrence (78.05% vs. 79.64%, = 0.295). EPD retrieved more positive lymph nodes (MD = 0.66, = 0.008), but did not improve prognosis. Postoperative morbidity (38.49% vs. 33.27%, = 0.072), mortality (1.97% vs. 1.33%, = 0.589), transfusion volume (MD = -31.27, = 0.469), and hospital stay (MD = -0.15, = 0.917) were comparable, though EPD increased operative time (MD = 53.24, < 0.001).
EPD reduces lymph node recurrence without improving OS or DFS, suggesting limited prognostic benefit. Its application in pancreatic cancer should be carefully considered.
https://www.crd.york.ac.uk/prospero, identifier CRD42024594566.
胰腺癌预后较差，手术切除是唯一的治愈选择。胰十二指肠切除术中的扩大淋巴结清扫术（EPD）可能会改善分期并降低复发率，但其相对于标准淋巴结清扫术（SPD）的生存获益仍存在争议。
于2025年3月25日对PubMed、Embase、Web of Science和Cochrane图书馆进行系统检索。所有符合纳入标准的研究均进行质量评估，随后采用荟萃分析方法进行分析。
分析了9项涉及1382例患者的随机对照试验。在总生存期（HR = 1.09，P = 0.384）、无病生存期（HR = 1.08，P = 0.506）或复发率（78.05%对79.64%，P = 0.295）方面，EPD与SPD之间未观察到显著差异。EPD获取的阳性淋巴结更多（MD = 0.66，P = 0.008），但并未改善预后。术后发病率（38.49%对33.27%，P = 0.072）、死亡率（1.97%对1.33%，P = 0.589）、输血量（MD = -31.27，P = 0.469）和住院时间（MD = -0.15，P = 0.917）相当，不过EPD增加了手术时间（MD = 53.24，P < 0.001）。
EPD可降低淋巴结复发率，但未改善总生存期或无病生存期，提示预后获益有限。其在胰腺癌中的应用应谨慎考虑。
