What do systematic reviews say?

Extended vs standard lymph node resection

It is very uncertain whether extended changes overall survival (3‐year compared with standard lymph node resection (very low certainty).

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  HR 0.12
  7 studies · 823 participants
  Very low

Extended vs standard lymph node resection

Extended showed no clear difference in postoperative mortality (duration of compared with standard lymph node resection (low certainty).

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  Peto OR 1.2 [0.51, 2.8]
  7 studies · 843 participants
  Low

Extended vs standard lymph node resection

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 670 participants
  Moderate

Extended vs standard lymph node resection

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 463 participants
  Very low

Extended vs standard lymph node resection

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 670 participants
  Moderate

Extended vs standard lymph node resection

It is very uncertain whether extended changes positive resection margins (R1 + R2) compared with standard lymph node resection (very low certainty).

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma 2021 · Cochrane Headline outcomes only
  RR 0.81 [0.58, 1.13]
  6 studies · 783 participants
  Very low

Chemotherapy vs placebo, best supportive care (BSC) or no treatment

Chemotherapy probably leads to lower overall survival compared with placebo, best supportive care (BSC) or no treatment (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 0.66 [0.52, 0.83]
  2 studies · 547 participants
  Moderate

Biological therapy vs placebo, best supportive care (BSC) or no treatment

Biological therapy showed no clear difference in any adverse events compared with placebo, best supportive care (BSC) or no treatment (high certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 1.08 [1, 1.17]
  1 study · 491 participants
  High

Biological therapy vs placebo, best supportive care (BSC) or no treatment

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 283 participants
  Low

Chemotherapy vs biological therapy

Chemotherapy showed no clear difference in overall survival compared with biological therapy (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 0.82 [0.66, 1.02]
  1 study · 395 participants
  Moderate

Chemotherapy vs biological therapy

Chemotherapy probably leads to higher progression‐free survival compared with biological therapy (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 1.27 [1.03, 1.57]
  1 study · 395 participants
  Moderate

Chemotherapy vs biological therapy

Chemotherapy may leads to lower serious adverse events compared with biological therapy (low certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 0.41 [0.3, 0.57]
  1 study · 570 participants
  Low

Chemotherapy vs biological therapy

Chemotherapy showed no clear difference in tumour response rate compared with biological therapy (low certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 1.17 [0.72, 1.88]
  1 study · 395 participants
  Low

Chemotherapy vs biological therapy

Chemotherapy probably leads to lower any adverse events compared with biological therapy (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 0.63 [0.56, 0.71]
  1 study · 570 participants
  Moderate

Chemmotherapy combined with biological therapy vs chemotherapy alone

Chemmotherapy combined with biological therapy showed no clear difference in overall survival compared with chemotherapy (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 0.93 [0.83, 1.04]
  7 studies · 2743 participants
  Moderate

Chemmotherapy combined with biological therapy vs chemotherapy alone

It is very uncertain whether chemmotherapy combined with biological therapy changes progression‐free survival compared with chemotherapy (very low certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 0.87 [0.74, 1.02]
  7 studies · 2743 participants
  Very low

Chemmotherapy combined with biological therapy vs chemotherapy alone

It is very uncertain whether chemmotherapy combined with biological therapy changes serious adverse events compared with chemotherapy (very low certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 1.17 [0.95, 1.44]
  4 studies · 1618 participants
  Very low

Chemotherapy vs placebo, best supportive care (BSC) or no treatment

Chemotherapy leads to lower progression‐free survival compared with placebo, best supportive care (BSC) or no treatment (high certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  HR 0.57 [0.47, 0.69]
  1 study · 507 participants
  High

Chemmotherapy combined with biological therapy vs chemotherapy alone

It is very uncertain whether chemmotherapy combined with biological therapy changes tumour response rate compared with chemotherapy (very low certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 1.35 [0.99, 1.85]
  6 studies · 2404 participants
  Very low

Chemmotherapy combined with biological therapy vs chemotherapy alone

Chemmotherapy combined with biological therapy showed no clear difference in any adverse events compared with chemotherapy (moderate certainty).

• Salvage systemic therapy for advanced gastric and oesophago‐gastric junction adenocarcinoma 2020 · Cochrane Headline outcomes only
  RR 1.01 [1, 1.03]
  3 studies · 1513 participants
  Moderate