Long-term survival after hepatic resection for liver metastasis from biliary tract / pancreatic cancer

Abstract

Background: The resection of the liver metastasis from biliary tract / pancreatic cancer has almost been given up, because of supposedly being a poor prognosis. Method: Between May 1990 and May 2017, 64 biliary tract / pancreatic cancer patients underwent hepatic resection with the intention of being cured. 21 had intra-hepatic cholangiocarcinoma (ICC), 9 had extra-hepatic cholangiocarcinoma (ECC), 12 had gallbladder carcinoma (GBC), 3 had ampullary carcinoma (APC), and 19 had pancreatic carcinoma (PAC). Results: The confirmed long-term survivors (≥60 months after hepatic resection) were 9. 3 ICC, 2 ECC, GBC, and APC patients respectively. None of PAC patients survived long-term. Interestingly, out of the 3 APC patients, 2 were long-term survivors without recurrence (69, 111 months), and the rest died without recurrence for 20 months. There are 2 relatively long-term survivors (≥30months) of PAC, who were high responders to chemotherapy. We divided them into two groups, a biliary tract group (BG; including ICC, ECC, GBC APC) and a pancreatic group (PG). The mean survival time of BG was 19.6 months and PG was 12.3 months (p=0.017). In the PG, univariate analysis revealed that variable predictors of better prognosis were the size (≤ 3 cm) of a tumor, number of tumors (≤ 3) and metachronous recurrence. Multivariate analysis revealed that number is the predictor. (p=0.012). Conclusions: Hepatic resection in the selected BG patients, especially APC patients may improve survival. For PAC patients, hepatic resection should not be recommended except for high responders to chemotherapy.