The prognosis of p
atients with liver met
ast
asis is gener
ally considered dism
al,
and combined resections of the prim
ary tumor
and met
ast
asectomies
are not recommended. In highly selected p
atients, however, resections
are performed. The evidence for this indic
ation is limited. The
aim of the current study w
as to
assess the oper
ative
and oncologic outcomes of p
atients with combined p
ancre
atic
and liver resections of synchronous liver met
ast
ases.
absSec_2">Methods
abspara0015">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.
absSec_3">Results
abspara0020">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).
absSec_4">Conclusion
abspara0025">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?