Objective: To compare standard with extended pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas: a meta-analysis of randomized controlled trials and prospective studies.
Methods: Randomized controlled trials and prospective studies comparing standard with extended pancreaticoduodenectomy for pancreatic cancer of head were identified using a systematic search of Medline, the Cochrane Library Databases and CBMDisc covering articles published from 1996 to 2005. Recommendations were based on the available level of evidence (A, large randomized; B, small randomized; C, prospective trial). A fixed-effect model and a random-effect model used vary with the heterogeneity test. Outcome of primary interest was operative morbidity, mortality and survival rates as well.
Results: Six RCTs trials and five prospective studies were included. Combined odds ratio for overall morbidity using random effect model was 1.82 (95% CI = 0.68 to 4.90) and OR of overall mortality, 1, 3, 5-year survival rate using fixed effect model was 0.84 (95% CI = 0.28 to 2.55), 0.74 (95% CI = 0.45 to 1.22), 0.90 (95% CI = 0.54 to 1.50), 0.90 (95% CI = 0.54 to 1.50), 1.43 (95% CI = 0.45 to 4.55) respectively. and indicated no significant difference.
Conclusions: No evidence was found that extended pancreaticoduodenectomy leads to longer survival than standard group (A level). There is no significant difference between standard and extended group in morbidity and mortality. Whipple procedure is also of choice for pancreatic head carcinoma and extended pancreaticoduodenectomy is indicated for lymph node positive patient (A-level).