C Schwarz1, F Fitschek1, F Primavesi2, S Stättner2, G A Margonis3, M A Weiss4, G A Stavrou5, K J Oldhafer5, P Kornprat6, H Wundsam7, I Fischer7, F Längle8, R Függer7, A Hauer9, R Klug9, M Kieler10, G Prager10, M Schindl1, S Stremitzer1, M Bodingbauer1, K Sahora11, K Kaczirek1. 1. Department of Surgery/Division of General Surgery, Medical University Vienna, Austria. 2. Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria. 3. Department of Surgery, Johns Hopkins University, Baltimore, USA. 4. Department of Surgery, Northwell Health Cancer Institute, New York, USA. 5. Department of Surgery, Division of HPB Surgery, Asklepios Campus Barmbek, Hamburg, Germany; Semmelweis University Budapest, Asklepios Campus Hamburg, Germany. 6. Department of Surgery, Medical University Graz, Graz, Austria. 7. Department of Surgery, Hospital Sisters of Mercy Linz, Linz, Austria. 8. Department of Surgery, LK Wiener Neustadt, Wiener Neustadt, Austria. 9. Department of Surgery, KH Horn, Austria. 10. Department of Internal Medicine/Division of Oncology, Medical University Vienna, Austria. 11. Department of Surgery/Division of General Surgery, Medical University Vienna, Austria. Electronic address: klaus.sahora@meduniwien.ac.at.
Abstract
BACKGROUND: The value of liver resection (LR) for metachronous pancreatic ductal adenocarcinoma (PDAC) metastases remains controversial. However, in light of increasing safety of liver resections, surgery might be a valuable option for metastasized PDAC in selected patients. METHODS: We performed a retrospective, multicenter study including patients undergoing hepatectomy for metachronous PDAC liver metastases between 2004 and 2015 to analyze postoperative outcome and overall survival. All patients were operated with curative intent. Patients with oligometastatic metachronous liver metastasis with definitive chemotherapy (n = 8) served as controls. RESULTS: Overall 25 patients in seven centers were included in this study. The median age at the time of LR was 63.8 years (56.9-69.9) and the median number of metastases in the liver was 1 (IQR 1-2). There were eight non-anatomical resections (32%), 15 anatomical minor (60%) and 2 major LR (8%). Postoperative complications occurred in eleven patients (eight Clavien-Dindo grade I complications (32%) and three grade IIIa complications (12%), respectively). The 30-day mortality was 0%. The median length of stay was 8.6 days (IQR 5-11). Median overall survival following LR was 36.8 months compared to 9.2 months in patients with metachronous liver metastasis with chemotherapy (p = 0007). DISCUSSION: Liver resection for metachronous PDAC metastasis is safe and feasible in selected patients. To address general applicability and to find factors for patient selection, larger trials are urgently warranted.
BACKGROUND: The value of liver resection (LR) for metachronous pancreatic ductal adenocarcinoma (PDAC) metastases remains controversial. However, in light of increasing safety of liver resections, surgery might be a valuable option for metastasized PDAC in selected patients. METHODS: We performed a retrospective, multicenter study including patients undergoing hepatectomy for metachronous PDAC liver metastases between 2004 and 2015 to analyze postoperative outcome and overall survival. All patients were operated with curative intent. Patients with oligometastatic metachronous liver metastasis with definitive chemotherapy (n = 8) served as controls. RESULTS: Overall 25 patients in seven centers were included in this study. The median age at the time of LR was 63.8 years (56.9-69.9) and the median number of metastases in the liver was 1 (IQR 1-2). There were eight non-anatomical resections (32%), 15 anatomical minor (60%) and 2 major LR (8%). Postoperative complications occurred in eleven patients (eight Clavien-Dindo grade I complications (32%) and three grade IIIa complications (12%), respectively). The 30-day mortality was 0%. The median length of stay was 8.6 days (IQR 5-11). Median overall survival following LR was 36.8 months compared to 9.2 months in patients with metachronous liver metastasis with chemotherapy (p = 0007). DISCUSSION: Liver resection for metachronous PDAC metastasis is safe and feasible in selected patients. To address general applicability and to find factors for patient selection, larger trials are urgently warranted.
Authors: Florentine E F Timmer; Bart Geboers; Sanne Nieuwenhuizen; Evelien A C Schouten; Madelon Dijkstra; Jan J J de Vries; M Petrousjka van den Tol; Martijn R Meijerink; Hester J Scheffer Journal: Cancers (Basel) Date: 2021-03-31 Impact factor: 6.639