Abstract
BackgroundThe role of surgery for circumscribed synchronous hepatic lesions of the pancreatic ductal adenocarcinoma (PDAC) remains controversial. Thus, the aim of our study was to compare survival outcome (OS) after surgery of patients with hepatic metastases (M1surg) to patients with only localized disease.MethodsCorrelation analysis of clinicopathological data and OS after resection of M1surg patients and patients with localized PDACs (M0) was performed. Patients were included for survival analysis only if a complete staging including perineural, venous and lymphatic invasion was available.ResultsOut of the study collective, 35 patients received extended surgery (M1surg), whereas 131 patients received standardized surgery for localized disease (M0). Length of hospitalization and mortality was similar in both groups. FOLFIRNOX as an adjuvant treatment regime was administered in ~ 23 and ~ 8% of M1surg and M0 patients, respectively. In subgroup analysis of R0 resected patients and in multivariate analysis of the total cohort, there was no difference in overall survival between both groups. Only the resection status (R1 vs R0) and venous invasion (V1) were identified as independent prognostic factors. Site of recurrence in R0 resected M1surg patients and in M0 patients were homogenously distributed.ConclusionThis is the first study demonstrating a survival benefit after extended surgery for synchronously hepatic-metastasized PDACs. We found no difference in survival outcome of metastasized patients when compared to patients with localized disease. FOLFIRINOX as an adjuvant treatment regime for resected M1surg presumably is worthwhile. Larger multicenter studies are still needed to validate our results.
Highlights
The role of surgery for circumscribed synchronous hepatic lesions of the pancreatic ductal adenocarcinoma (PDAC) remains controversial
Further 14 patients with oligometastatic disease to the liver and a similar ECOG performance status to group M0 and M1surg, who did not agree on an extended surgical approach, were treated with a palliative intended chemotherapy according to national guidelines [12]
Taking the revised eighth edition TNM staging system into account with inclusion of lymphatic, perineural, and venous infiltration, our data demonstrated that patients with isolated synchronous hepatic metastases showed a similar overall survival in multivariate analysis compared to patients with localized disease
Summary
The role of surgery for circumscribed synchronous hepatic lesions of the pancreatic ductal adenocarcinoma (PDAC) remains controversial. The aim of our study was to compare survival outcome (OS) after surgery of patients with hepatic metastases (M1surg) to patients with only localized disease. Results Out of the study collective, 35 patients received extended surgery (M1surg), whereas 131 patients received standardized surgery for localized disease (M0). Conclusion This is the first study demonstrating a survival benefit after extended surgery for synchronously hepatic-metastasized PDACs. We found no difference in survival outcome of metastasized patients when compared to patients with localized disease. The only curative therapy remains the margin-negative oncological resection with an adjuvant treatment regime starting within 6 weeks of the operation [3, 4]. At diagnosis of PDAC, 50% of patients have already metastasized synchronously and further 30% presented with locally advanced disease, which is not suitable for surgery. It is still regarded as one of the most lethal cancers indicated by a very high mortalityto-incidence ratio [5, 7]
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