Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages

Table 1 Extent of extended lymphadenectomy and standard lymphadenectomy in pancreatic head carcinoma

Location	Standard lymphadenectomy	Extended lymphadenectomy
Superior pyloric (No.5)	O	O
Inferior pyloric (No.6)	O	O
Anterior CHA (No.8a)	O	O
Posterior CHA (No.8p)	X	O
Celiac axis (No.9)	X	O
Proper hepatic artery (No.12a)	X	O
Bile duct (No.12b)	O	O
Cystic duct (No.12c)	O	O
Portal vein (No.12p)	X	O
Posterior pancreaticoduodenal (No.13a-b)	O	O
Origin and right side of SMA (No.14a-b)	X	O
Left side of SMA(No.14c-d)	X	O
Celiac axis to IMA (No.16a2, No.16b1)	X	O
Anterior pancreaticoduodenal (No.17a-b)	O	O

O: Dissected; X: Not dissected; CHA: Common hepatic artery; SMA: Superior mesenteric artery; IMA: Inferior mesenteric artery.

Table 2 General data between extended and standard lymphadenectomy group in pancreatic head carcinoma patients

Variables	ELD group (n = 88)	SLD group (n = 128)	P value
Gender (male/female)	51/37	73/55	0.893
Age (yr)	62.1 ± 11.0	64.6 ± 10.0	0.080
TB (μmol/L)	62.6 (15.3, 144.6)	57.7 (12.7, 143.4)	0.679
CA19-9 (U/ml)	161.8 (38.5, 544.9)	202.1 (44.9, 773.2)	0.342
Intraoperative blood loss (mL)	500 (400, 800)	600 (400, 800)	0.332
Operation time (h)	11.1 ± 2.8	11.0 ± 2.9	0.693
Tumor size (cm)	3.5 ± 1.4	3.5 ± 1.7	0.790
Tumor differentiation (poorly/ modrately& highly)	25/63	47/81	0.203
Portal vein invasion (yes/no)	47/41	69/59	0.943
Lymph node metastasis (yes/no)	54/34	91/37	0.135
Retrieved lymph node count	25 (18, 35)	19 (14, 28)	0.001
Positive lymph node count	1 (0, 4)	2 (0, 3)	0.614
Resection margin (R0/R1)	83/5	118/10	0.545
Postoperative chemotherapy (yes/no)	48/40	61/67	0.320

ELD: Extended lymphadenectomy; SLD: Standard lymphadenectomy; TB: Total bilirubin; CA19-9: Carbohydrate antigen 199; R: Resection margin.

Table 3 Perioperative complications between extended and standard lymphadenectomy group in pancreatic head carcinoma patients

Variables	ELD (n = 88)	SLD (n = 128)	P value
Perioperative death	2	5	0.783
Postoperative complications	27	42	0.741
Biochemical fistula	3	6	0.908
Pancreatic fistula (grade B/C)	4	6	0.779
DGE	9	15	0.732
Diarrhea	22	4	< 0.001
Abdominal infection	9	13	0.987
Abdominal hemorrhage	3	4	0.783

ELD: Extended lymphadenectomy; SLD: Standard lymphadenectomy; DGE: Delayed gastric emptying.

Table 4 General data between extended and standard lymphadenectomy group in pancreatic head carcinoma patients at different T stages

Variables	T1 stage			T2 stage			T3 stage
	ELD group (n = 16)	SLD group (n = 28)	P value	ELD group (n = 51)	SLD group (n = 76)	P value	ELD group (n = 21)	SLD group (n = 24)	P value
Gender (male/female)	10/6	14/14	0.423	32/19	46/30	0.801	9/12	13/11	0.449
Age (yr)	62.8 ± 12.4	64.1 ± 9.7	0.696	64.2 ± 9.8	64.7 ± 10.3	0.801	56.2 ± 10.9	64.8 ± 9.7	0.001
TB (μmol/L)	58.1 (16.8, 107.5)	72.3 (28.1, 149.0)	0.742	80.8 (14.6, 149.3)	60.6 (12.7, 168.7)	0.885	44.4 (13.0, 137.7)	29.4 (10.3, 96.8)	0.285
CA19-9 (U/mL)	115.9 (24.0, 262.8)	92.5 (38.7, 312.5)	0.817	152.7 (53.7, 545.9)	207.0 (43.5, 1058.9)	0.507	180.2 (39.6, 556.4)	424.5 (77.8, 1285.6)	0.270
Intraoperative blood loss (mL)	500 (400, 600)	500 (400, 650)	0.788	500 (400, 800)	600 (400, 800)	0.310	500 (400, 1000)	550 (400, 1000)	0.741
Operation time (h)	10.8 ± 3.5	9.5 ± 2.9	0.194	10.9 ± 2.5	11.3 ± 2.7	0.404	11.9 ± 3.0	11.6 ± 3.2	0.746
Tumor size (cm)	1.7 ± 0.4	1.8 ± 0.3	0.274	3.2 ± 0.5	3.4 ± 0.5	0.193	5.4 ± 1.0	6.1 ± 2.0	0.155
Tumor differentiation (poorly/moderately-highly)	2/14	11/17	0.126	14/37	24/52	0.619	9/12	12/12	0.632
Portal vein invasion (yes/no)	4/12	6/22	0.919	28/23	45/31	0.630	15/6	18/6	0.787
Lymph node metastasis (yes/no)	10/6	15/13	0.565	31/20	55/21	0.171	15/6	23/5	0.587
Retrieved lymph node count	21 (18, 32)	15 (12, 19)	0.004	26 (21, 33)	23 (16, 31)	0.509	25 (15, 40)	20 (15, 30)	0.030
Positive lymph node count	2 (0, 2)	1 (0, 2)	0.373	1 (0, 4)	2 (0, 4)	0.513	1 (0, 3)	4 (1, 5)	0.022
Resection margin (R0/R1)	16/0	28/0	-	48/3	68/8	0.555	19/2	22/2	0.700
Postoperative chemotherapy (yes/no)	6/10	15/13	0.305	29/22	36/40	0.294	13/8	10/14	0.175

ELD: Extended lymphadenectomy; SLD: Standard lymphadenectomy; TB: Total bilirubin; CA19-9: Carbohydrate antigen 199; R: Resection margin.

Table 5 Perioperative complications between extended and standard lymphadenectomy group in pancreatic head carcinoma patients at different T stages

Variable	T1 stage			T2 stage			T3 stage
	ELD group (n = 16)	SLD group (n = 28)	P value	ELD group (n = 51)	SLD group (n = 76)	P value	ELD group (n = 21)	SLD group (n = 24)	P value
Perioperative death	0	1	1.000	2	4	0.938	0	0	-
Postoperative complications	4	12	0.391	14	25	0.514	9	5	0.111
Biochemical fistula	1	3	0.961	1	3	0.912	1	0	0.467
Pancreatic fistula (grade B/C)	0	3	0.463	4	3	0.585	0	0	-
DGE	2	4	0.771	4	10	0.349	3	1	0.506
Diarrhea	3	1	0.254	12	2	< 0.001	7	1	0.031
Abdominal infection	1	3	0.961	5	8	0.895	3	2	0.874
Abdominal hemorrhage	0	1	1.000	3	3	0.938	0	0	-

ELD: Extended lymphadenectomy; SLD: Standard lymphadenectomy; DGE: Delayed gastric emptying.

Table 6 Univariate analysis of long-term prognosis in pancreatic head carcinoma patients at T3 stage

Variables	Number (n = 45)	yr OS (%)	3-yr OS (%)	χ2	P value
Gender				0.004	0.949
Male	22	46.8	13.7
Female	23	54.1	10.8
Age (yr)				2.192	0.139
≤ 60	22	60.2	20.1
> 60	23	43.6	5.5
CA19-9 (U/mL)				1.504	0.220
≤ 37	9	59.3	29.6
> 37	36	48.9	7.5
Operation time (h)				2.647	0.104
≤ 10	18	63.2	19.0
> 10	27	42.5	6.1
Intraoperative blood loss (mL)				0.253	0.615
≤ 800	30	49.2	16.5
> 800	15	55.9	0
Tumor differentiation				0.996	0.318
Poorly	21	39.3	8.2
Moderately-highly	24	59.9	15.0
Lymph node metastasis				5.542	0.019
Yes	34	42.9	7.9
No	11	77.8	25.9
Positive lymph node count				0.569	0.451
≤ 3	33	52.9	8.2
> 3	12	46.3	23.1
Portal vein invasion				4.141	0.042
Yes	33	42.3	7.7
No	12	72.7	24.2
Resection margin				0.035	0.852
R0	41	48.1	13.9
R1	4	75.0	0
Extent of lymphadenectomy				7.843	0.005
ELD	21	65.3	21.8
SLD	24	36.1	0
Postoperative chemotherapy				0.027	0.869
Yes	23	41.5	11.9
No	22	61.2	12.4

TB: Total bilirubin; CA19-9: Carbohydrate antigen 19-9; R: Resection margin; ELD: Extended lymphadenectomy; SLD: Standard lymphadenectomy; OS: Overall survival.

Table 7 Cox multivariate regression analysis of long-term prognosis in pancreatic head carcinoma patients at T3 stage

Variables	RR	95%CI	P value
Lymph node metastasis	1.915	0.724-5.063	0.190
Portal vein system invasion	2.471	1.028-5.942	0.043
Extent of lymphadenectomy	2.395	1.065-5.383	0.035

RR: Relative risk; CI: Confidence interval.