Lymph-node dissection in pancreatic cancer - what are the facts?

Background. The surgical therapy of ductal adenocarcinoma of the pancreas is well standardized around the world, with the exception of the extent of the resection of regional lymph nodes and peripancreatic soft tissue. This much-debated issue has become apparent after several Japanese reports that were able to demonstrate better survival after extensive lymph-node clearance. These results, however, could not be achieved using similar techniques in the Western world. The reason for these apparent differences in surgical results result from the application of two different staging systems (UICC and JPS) and the fact that the study designs of the compared trials are not comparable. The most desirable source of information coming from a randomized controlled study is, to date, only available from one trial which was not able to demonstrate a significant survival difference. Conclusion: So far, there is no substantial proof that extensive lymph-node clearance is beneficial for the patient. It has been shown, however, that in specialized centers these procedures do not carry an increased risk of perioperative morbidity and mortality compared with standard resections. In those institutions, the efficacy of extended resections needs to be further evaluated in prospective randomized trials, preferably based on the "International Documentation System for Pancreatic Cancer", which allows data acquisition independent of the staging system applied.