Michael Tachezy1, Florian Gebauer2, Monika Janot3, Waldemar Uhl3, Alessandro Zerbi4, Marco Montorsi4, Julie Perinel5, Mustapha Adham5, Christos Dervenis6, Christos Agalianos6, Giuseppe Malleo7, Laura Maggino7, Alexander Stein8, Jakob R Izbicki1, Maximilian Bockhorn1. 1. Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. 2. Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. Electronic address: fgebauer@uke.de. 3. Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr-University, Bochum, Germany. 4. Department of General Surgery, University of Milan, Instituto Clinico Humanitas IRCCS, Milan, Italy. 5. Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon Faculty of Medicine - UCBL1, Lyon, France. 6. Department of Surgery, Agia Olga Hospital, Athens, Greece. 7. Department of Surgery, Unit of Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. 8. Department of Oncology, Hematology, BMT with section Pneumology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
Abstract
BACKGROUND: The prognosis of patients with liver metastasis is generally considered dismal, and combined resections of the primary tumor and metastasectomies are not recommended. In highly selected patients, however, resections are performed. The evidence for this indication is limited. The aim of the current study was to assess the operative and oncologic outcomes of patients with combined pancreatic and liver resections of synchronous liver metastases. METHODS: In a retrospective analysis of 6 European pancreas centers, we identified 69 patients with pancreatic ductal adenocarcinoma and synchronous liver metastasis who underwent simultaneous pancreas and liver metastasis resections. Patients receiving exploration without tumor resection served as the control group. RESULTS: Overall survival (OS) appeared to be prolonged in the group of resected patients (median 14 vs 8 months, P < .001). Subgroup analysis revealed that the survival benefit of the resected patients was driven by pancreatic ductal adenocarcinomas localized in the pancreatic head (median OS 13.6 vs 7 months, P < .001). Body/tail pancreatic ductal adenocarcinomas showed no benefit of resection (median OS 14 vs 15 months, P = .312). In the multivariate analysis, tumor resection was the only independent prognosticator for OS (hazard ratio 2.044, 95% confidence interval 1.342-3.114). CONCLUSION: The data of this retrospective and selective patient cohort suggested a clear survival benefit for patients undergoing synchronous pancreas and liver resections for pancreatic ductal adenocarcinoma, but due to the limitations of this retrospective study and very strong potential for selection bias, a strong conclusion for resection cannot be drawn. Prospective trials must validate these data and investigate the use of combined operative and systemic treatments in case of resectable metastatic pancreatic cancer. Is it time for a multicenter, prospective trial?
BACKGROUND: The prognosis of patients with liver metastasis is generally considered dismal, and combined resections of the primary tumor and metastasectomies are not recommended. In highly selected patients, however, resections are performed. The evidence for this indication is limited. The aim of the current study was to assess the operative and oncologic outcomes of patients with combined pancreatic and liver resections of synchronous liver metastases. METHODS: In a retrospective analysis of 6 European pancreas centers, we identified 69 patients with pancreatic ductal adenocarcinoma and synchronous liver metastasis who underwent simultaneous pancreas and liver metastasis resections. Patients receiving exploration without tumor resection served as the control group. RESULTS: Overall survival (OS) appeared to be prolonged in the group of resected patients (median 14 vs 8 months, P < .001). Subgroup analysis revealed that the survival benefit of the resected patients was driven by pancreatic ductal adenocarcinomas localized in the pancreatic head (median OS 13.6 vs 7 months, P < .001). Body/tail pancreatic ductal adenocarcinomas showed no benefit of resection (median OS 14 vs 15 months, P = .312). In the multivariate analysis, tumor resection was the only independent prognosticator for OS (hazard ratio 2.044, 95% confidence interval 1.342-3.114). CONCLUSION: The data of this retrospective and selective patient cohort suggested a clear survival benefit for patients undergoing synchronous pancreas and liver resections for pancreatic ductal adenocarcinoma, but due to the limitations of this retrospective study and very strong potential for selection bias, a strong conclusion for resection cannot be drawn. Prospective trials must validate these data and investigate the use of combined operative and systemic treatments in case of resectable metastatic pancreatic cancer. Is it time for a multicenter, prospective trial?
Authors: Rohan R Katipally; Sean P Pitroda; Aditya Juloori; Steven J Chmura; Ralph R Weichselbaum Journal: Nat Rev Clin Oncol Date: 2022-07-12 Impact factor: 65.011
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