To evaluate the application value of extended lymph node dissection in surgical resection of borderline resectable pancreatic head cancer.

Clinical data of 94 patients with borderline resectable pancreatic head cancer admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2015 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 41 patients were male and 53 female, aged from 29 to 78 years, with a median age of 62 years. All patients were divided into the extended lymph node dissection group (extended dissection group, n=50) and standard lymph node dissection group (standard dissection group, n=44). The perioperative conditions and survival of patients in two groups were observed. The number of resected lymph nodes between two groups were compared by rank-sum test. The incidence of complications and mortality between two groups were statistically compared by Chi-square test or Fisher's exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

The surgery of all 94 patients were completed successfully. The total incidence of postoperative complications in the extended dissection group was 34%(17/50) and 30%(13/44) in the standard dissection group, where no significant difference was observed (χ²=0.214, P>0.05). No death case was noted in the extended dissection group, and 2 cases died in the standard dissection group, where no significant difference was observed (P=0.419). The number of resected lymph nodes in the extended dissection group was 25(15), significantly higher than 18(15) in the standard dissection group (Z=2.243, P<0.05). The incidence of postoperative diarrhea in the extended dissection group was 30%(15/50), which was significantly higher than 7%(3/44) in the standard dissection group (χ²=8.124, P<0.05). The 1-, 2-, 3-year disease-free survival rates in the extended group were 54.1%, 44.4%, 27.3%, and 34.9%, 19.0%, 19.0% in the standard dissection group, respectively, significant difference was noted between two groups (χ²=5.571, P<0.05). The 1-, 2-, 3-year overall survival rates in the extended group were 66.1%, 49.9%, 29.7%, and 48.8%, 16.7%, 16.7% in the standard dissection group, respectively, significant difference was noted between two groups (χ²=8.350, P<0.05).

Extended lymph node dissection contributes to improving the long-term prognosis of patients with borderline resectable pancreatic head cancer, which does not increase the total incidence of perioperative complications or mortality, but the incidence of postoperative diarrhea may increased.