Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality

• Published in: Annals of surgery 2002-09, Vol.236 (3), p.355-368
• Main Authors: Yeo, Charles J, Cameron, John L, Lillemoe, Keith D, Sohn, Taylor A, Campbell, Kurtis A, Sauter, Patricia K, Coleman, JoAnn, Abrams, Ross A, Hruban, Ralph H
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Ampulla of Vater - surgery; Common Bile Duct Neoplasms - mortality; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; Female; Gastrectomy - methods; Gastrectomy - mortality; Humans; Lymph Node Excision - mortality; Male; Middle Aged; Pancreatic Ducts - surgery; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Prospective Studies; Retroperitoneal Space; Scientific Papers; Survival Rate
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200209000-00012

To evaluate, in a prospective, randomized single-institution trial, the end points of operative morbidity, operative mortality, and survival in patients undergoing standard versus radical (extended) pancreaticoduodenectomy. Numerous retrospective reports and a few prospective randomized trials have suggested that the performance of an extended lymphadenectomy in association with a pancreaticoduodenal resection may improve survival for patients with pancreatic and other periampullary adenocarcinomas. Between April 1996 and June 2001, 299 patients with periampullary adenocarcinoma were enrolled in a prospective, randomized single-institution trial. After intraoperative verification (by frozen section) of margin-negative resected periampullary adenocarcinoma, patients were randomized to either a standard pancreaticoduodenectomy (removing only the peripancreatic lymph nodes en bloc with the specimen) or a radical (extended) pancreaticoduodenectomy (standard resection plus distal gastrectomy and retroperitoneal lymphadenectomy). All pathology specimens were reviewed, fully categorized, and staged. The postoperative morbidity, mortality, and survival data were analyzed. Of the 299 patients randomized, 5 (1.7%) were subsequently excluded because their final pathology failed to reveal periampullary adenocarcinoma, leaving 294 patients for analysis (146 standard vs. 148 radical). The two groups were statistically similar with regard to age (median 67 years) and gender (54% male). All the patients in the radical group underwent distal gastric resection, while 86% of the patients in the standard group underwent pylorus preservation (