Abstract
BackgroundDuctal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases.MethodsPatients with isolated resectable local recurrence, metachronous hepatic or pulmonary metastases were included for survival analyses. PRS of surgically treated patients (local (n = 11), hepatic (n = 6) and pulmonary metastases (n = 9)) was compared to conservatively treated patients (local (n = 17), hepatic (n = 37) and pulmonary metastases (n = 8)).ResultsResected PDAC patients suffering from isolated metachronous hepatic metastases initially had a higher T-stage and venous invasion (V1) compared to the other patients. DFS in the metachronous pulmonary metastases group was longer compared to DFS of the hepatic metastases and local recurrence groups. Surgical resection significantly improved PRS in patients with local recurrence and pulmonary metastases, when compared to patients receiving chemotherapy alone. Very-long term survivors (> 5 years) were detected following secondary resection of local recurrence and 45% of these patients were still alive at the end of our study period.ConclusionAlthough DFS in PDAC patients suffering from isolated local recurrence was dismal and comparable to that of patients with isolated hepatic metastases, very-long term survivors were present only in this group. These results indicate that a surgical approach for isolated local recurrence, if anatomically possible, should be considered.
Highlights
Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies
In 128 patients, the primary Pancreatic ductal adenocarcinoma (PDAC) was located in the pancreatic head (90.8%) while in 13 patients (9.2%) the tumor originated from the pancreatic tail (Table 1)
We could show for the first time that disease free survival (DFS) was longer in patients with isolated pulmonary metastases when compared to patients with metachronous hepatic metastases and local recurrence
Summary
Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. No guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases. Upfront surgery and adjuvant chemotherapy for patients with localized and resectable PDAC are indispensable in the treatment of this disease [8]. No guidelines exist for the treatment of metachronous PDAC metastases and treatment options are individualized due to a lack of clinical investigation. One possibility to stratify patients for an individualized treatment regime is the genomic sequencing of primary tumor and metastases. Following the success of similar standardized genomic approaches in other tumor entities, this targeted approach is going to be of interest in PDAC treatment in the future [9,10,11]
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