Surgical resection of liver metastasis in pancreatic and periampullary carcinoma

Abstract

Introduction: Once liver metastases in pancreatic and periampullary carcinoma are diagnosed, the guidelines do not recommend resection of the primary tumor. In this stage of the disease, therapeutic regimes with chemotherapy are the stantadard treatment. However, it is unclear whether combinations of extensive surgery and novel chemotherapy treatments confer a survival benefit in selected patients. Material and Methods We provide a systematic review about liver metastases in pancreatic and periampullary carcinoma treated by surgery utilizing EMBASE, Medline/Pubmed, Cochrane and Scopus databases according to PRISMA guidelines. Results for pancreatic and periampullary carcinoma the number of lesions that can be resected, include a mean or median of between 1-3; the size of the lesions should not exceed 3 cm and the most frequent surgical technique used were wedge or atypical resections. Overall morbidity and mortality after liver resection from pancreas was 0-68% and 0-9.1% respectively, and from periampullary carcinomas was 0-82% and 0-21%, respectively. In both carcinomas the rate of recurrence was up to 91%. Median overall survival ranged from 5.5 to 16.6 months for liver metastases from pancreas carcinoma and 5 to 23 months from periampullary tumors with better prognosis to duodenal carcinomas. Conclusions Perioperative chemotherapy is the cornerstone of treatment in patients with liver metastasis from pancreatic and periampullary carcinoma. Liver resection from early liver metastases could be acceptable in selected patients with oligometastasic disease and small single lesions taking into account the individual risk of complications.