SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1622966
Outcomes of Extended versus Standard lymphadenectomy in Pancreatoduodenectomy for Pancreatic Cancer: Systematic Review and Meta-analysis
Provisionally accepted
- 1The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- 2the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Background: 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. Methods: 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. Results: Nine RCTs involving 1382 patients were analyzed. No significant differences were observed between EPD and SPD in OS (HR = 1.09, p = 0.384), DFS (HR = 1.08, p = 0.506), or recurrence (78.05% vs. 79.64%, p = 0.295). EPD retrieved more positive lymph nodes (MD = 0.66, p = 0.008), but did not improve prognosis. Postoperative morbidity (38.49% vs. 33.27%, p = 0.072), mortality (1.97% vs. 1.33%, p = 0.589), transfusion volume (MD = -31.27, p = 0.469), and hospital stay (MD = -0.15, p = 0.917) were comparable, though EPD increased operative time (MD = 53.24, p < 0.001). Conclusions: EPD reduces lymph node recurrence without improving OS or DFS, suggesting limited prognostic benefit. Its application in pancreatic cancer should be carefully considered.
Keywords: Pancreatic Cancer, Lymphadenectomy, prognosis, complications, Meta-analysis
Received: 05 May 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Xu, Shi and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiao-Feng Li, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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