Extended pancreatic resections and lymphadenectomy: An appraisal of the current evidence

Table 1 Multi-visceral resections for pancreatic cancer (where studies have included vascular resections in the analysis this has been specified)

Author (Ref)	Year	Number of patients	Neoadjuvant therapy	Organs resected	Morbidity/Mortality	Survival	Conclusions
Klempnauer et al[54]	1996	45	Not specified	Colon, stomach, liver, kidney, adrenal	31%/17.7%	5-YSR = 11.9% Median survival = 7.3 mo (n = 34)	Increased mortality and impaired long-term prognosis
Sasson et al[20]	2002	37	76% (5-FU or Gemcitabine)	Colon & mesocolic vessels, celiac axis, portal vein, liver, adrenal, stomach	35%/2.7%	5-YSR = 16% (P < 0.08 in favour of en bloc resections)	Safe; beneficial in selected patients who receive neoadjuvant therapy
Hartwig et al[51]	2009	101	20.8%	Colon, stomach, adrenal gland, liver, hepatic or celiac artery, kidney, or small intestine	37.6%/3%	3-YSR = 37.2%	Increased morbidity; Comparable mortality and long-term outcomes
1Nikfarjam et al[52]	2009	7 (19)	Not specified	Colon, kidney, liver	68%/0%	Not specifically addressed	Comparable morbidity to routine PD
Shoup et al[55]	2003	22	Not specified	Colon, stomach, adrenal, portal vein	Not specified	5-YSR = 22% 10-YSR = 18%	Markedly improved survival as compared to those not resected

¹Includes resections for tumours that infiltrated the pancreas from the retroperitoneum, also includes PDs performed for GISTs; Abbreviations: 5-FU: 5-Fluorouracil; YSR: Year survival rate; PD: Pancreatoduodenectomy.