Metachronous hepatic resection for liver only pancreatic metastases

Schwarz, Christian; Fitschek, Fabian; Primavesi, Florian; Stättner, Stefan; Margonis, Georgios Antonios; Weiss, Matthew; Stavrou, Gregor A.; Oldhafer, Karl J.; Kornprat, Peter; Wundsam, Helwig; Fischer, Ines; Längle, F.; Függer, R.; Hauer, A.; Klug, R.; Kieler, Markus; Prager, Gerhard; Schindl, Martin; Stremitzer, Stefan; Bodingbauer, Martin; Sahora, Klaus; Kaczirek, Klaus

doi:10.1016/j.suronc.2020.08.005

Cited by 24 publications

(41 citation statements)

References 27 publications

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“…Although no standard adjuvant chemotherapy for PDAC has been established, several gemcitabine-based adjuvant therapies have been investigated [ 21 ], and previous studies reported that systemic intra-arterial chemotherapy appeared to be effective against liver metastasis [ 22 , 23 ]. Furthermore, hepatectomy for recurrent PDAC was applied in a German national cancer center and was proven to be safe and beneficial [ 24 , 25 ]. Now that both chemotherapy and hepatectomy have proven successful in improving survival, the relevant specific regimens are worth further study for patients with early liver metastasis after operation.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Tong

et al. 2022

Gastroenterology Research and Practice

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Background. Liver metastasis arises in many postoperative patients with PDAC, occurring in the early stage appears to lead to a very poor prognosis. Objective. We aimed to analyze the risk factors for early liver metastasis after radical resection for patients with pancreatic ductal adenocarcinoma (PDAC) and to indicate the poor prognosis of early liver metastasis. Methods. Patients who underwent pancreatectomy for PDAC at the Ningbo Medical Centre Lihuili Hospital between January 2015 and June 2021 were included. The exclusion criteria were death within 30 days after the operation, complications with other malignancies, and a positive final resection margin (R1). Liver metastasis and its occurrence time were recorded, and risk factors for early (≤6 months) liver metastasis were analyzed by logistic regression models. The prognosis of patients with early liver metastasis and different recurrence patterns was analyzed by Kaplan–Meier curves and the log-rank test. Results. From the identified cohort of 184 patients, 172 patients were included for further analysis. 55 patients developed early liver metastasis within 6 months after the operation. Univariate analysis showed that CA 125 ≥ 30 IU / ml , tumor size ≥ 4 cm , poor tumor differentiation, and portal vein/superior mesenteric vein (PV/SMV) reconstruction were risk factors, and multivariate analysis showed that poor tumor differentiation and PV/SMV reconstruction were independent risk factors for early liver metastasis. The prognosis of liver metastasis was the worst among the different recurrence patterns. Early liver metastasis indicates a poor prognosis in patients with PDAC. Conclusions. Poor differentiation and PV/SMV reconstruction are independent risk factors for early liver metastasis in patients with PDAC, and early liver metastasis indicates a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Tong

et al. 2022

Gastroenterology Research and Practice

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“…Well/moderate differentiation of tumor (histological grade) [32] Lower tumor marker CA19-9 levels pre-and/or post-treatment(s) [33,34] Fewer and/or smaller lung lesions [34,35] Longer DFI [32,34,36] Ablation Younger age [37] Performance status 0-1 [37] Lower tumor stage [38] Tumor in pancreatic body/tail [39] Well/moderate differentiation of tumor (histological grade) [37,38,40] Neutrophil-to-lymphocyte ratio (NLR) < 2.5 [38] Fewer and/or smaller liver/lung lesions [37][38][39][40][41] Longer DFI [38,42] Single-organ metastatic disease [38] Embolization Male [43] Smaller primary tumor size [44] Lower tumor marker CA19-9 levels pre-or post-treatment(s) [45] Absence of ascites [44] Decreased albumin and bilirubin prior to local treatment [46] Fewer and/or smaller liver/lung lesions [47] Single-organ metastatic disease [48] Primary tumor resection [46] Local metastatic treatment [44]…”

Section: Primary Resectionmentioning

confidence: 99%

“…Five articles were published on the use of SBRT for mPDAC (Table 5). This ablative technique was utilized for both primary pancreatic [41,[68][69][70] as well as metastatic treatment [42,70]. The articles included 106 patients with mPDAC (53 synchronous, 39 metachronous disease, 14 unknown).…”

Section: Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Timmer

Geboers

Nieuwenhuizen

et al. 2021

Cancers

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The prognosis of metastatic pancreatic ductal adenocarcinoma (mPDAC) remains universally poor, requiring new and innovative treatment approaches. In a subset of oligometastatic PDAC patients, locoregional therapy, in addition to systemic chemotherapy, may improve survival. The aim of this systematic review was to explore and evaluate the current evidence on locoregional treatments for mPDAC. A systematic literature search was conducted on locoregional techniques, including resection, ablation and embolization, for mPDAC with a focus on hepatic and pulmonary metastases. A total of 59 studies were identified, including 63,453 patients. Although subject to significant bias, radical-intent local therapy for both the primary and metastatic sites was associated with a superior median overall survival from metastatic diagnosis or treatment (hepatic mPDAC 7.8–19 months; pulmonary mPDAC 22.8–47 months) compared to control groups receiving chemotherapy or best supportive care (hepatic mPDAC 4.3–7.6 months; pulmonary mPDAC 11.8 months). To recruit patients that may benefit from these local treatments, selection appears essential. Most significant is the upfront possibility of local radical pancreatic and metastatic treatment. In addition, a patient’s response to neoadjuvant systemic chemotherapy, performance status, metastatic disease load and, to a lesser degree, histological differentiation grade and tumor marker CA19-9 serum levels, are powerful prognostic factors that help identify eligible subjects. Although the exact additive value of locoregional treatments for mPDAC patients cannot be distillated from the results, locoregional primary pancreatic and metastatic treatment seems beneficial for a highly selected group of oligometastatic PDAC patients. For definite recommendations, well-designed prospective randomized controlled trials with strict in- and exclusion criteria are needed to validate these results.

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“…The incidence of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is increasing in Western countries and even tripled in the United States since 1980 1,2 . For these types of cancer, treatment options such as surgical resection, transplantation, ablation, trans‐arterial chemoembolization, and systemic therapy have proven to increase survival 3–6 . Worldwide, the (m)RECIST 1.1 criteria, which are based on computed tomography (CT) or magnetic resonance imaging (MRI) of (viable) tumor shrinkage or growth, are the most used criteria for cancer therapy response assessment 7,8 .…”

mentioning

confidence: 99%

“…1,2 For these types of cancer, treatment options such as surgical resection, transplantation, ablation, trans-arterial chemoembolization, and systemic therapy have proven to increase survival. [3][4][5][6] Worldwide, the (m)RECIST 1.1 criteria, which are based on computed tomography (CT) or magnetic resonance imaging (MRI) of (viable) tumor shrinkage or growth, are the most used criteria for cancer therapy response assessment. 7,8 However, these criteria have limitations due to delayed impact of treatment on tumor growth, resulting in misclassification of tumor response in patients.…”

mentioning

confidence: 99%

Prospective of ³¹P MR Spectroscopy in Hepatopancreatobiliary Cancer: A Systematic Review of the Literature

Seelen

Wildenberg

Kemp

et al. 2022

Magnetic Resonance Imaging

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Background: The incidence of liver and pancreatic cancer is rising. Patients benefit from current treatments, but there are limitations in the evaluation of (early) response to treatment. Tumor metabolic alterations can be measured noninvasively with phosphorus ( 31 P) magnetic resonance spectroscopy (MRS). Purpose: To conduct a quantitative analysis of the available literature on 31 P MRS performed in hepatopancreatobiliary cancer and to provide insight into its current and potential for therapy (non-) response assessment. Population: Patients with hepatopancreatobiliary cancer. Field Strength/Sequence: 31 P MRS. Assessment: The PubMed, EMBASE, and Cochrane library databases were systematically searched for studies published to 17 March 17, 2022. All 31 P MRS studies in hepatopancreatobiliary cancer reporting 31 P metabolite levels were included. Statistical Tests: Relative differences in 31 P metabolite levels/ratios between patients before therapy and healthy controls, and the relative changes in 31 P metabolite levels/ratios in patients before and after therapy were determined. Results: The search yielded 10 studies, comprising 301 subjects, of whom 132 (44%) healthy volunteers and 169 (56%) patients with liver cancer of various etiology. To date, 31 P MRS has not been applied in pancreatic cancer. In liver cancer, alterations in levels of 31 P metabolites involved in cell proliferation (phosphomonoesters [PMEs] and phosphodiesters [PDEs]) and energy metabolism (ATP and inorganic phosphate [Pi]) were observed. In particular, liver tumors were associated with elevations of PME/PDE and PME/Pi compared to healthy liver tissue, although there was a broad variety among studies (elevations of 2%-267% and 21%-233%, respectively). Changes in PME/PDE in liver tumors upon therapy were substantial, yet very heterogeneous and both decreases and increases were observed, whereas PME/Pi was consistently decreased after therapy in all studies (À13% to À76%). Data Conclusion: 31 P MRS has great potential for treatment monitoring in oncology. Future studies are needed to correlate the changes in 31 P metabolite levels in hepatopancreatobiliary tumors with treatment response.

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Metachronous hepatic resection for liver only pancreatic metastases

Cited by 24 publications

References 27 publications

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Prospective of ³¹P MR Spectroscopy in Hepatopancreatobiliary Cancer: A Systematic Review of the Literature

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Metachronous hepatic resection for liver only pancreatic metastases

Cited by 24 publications

References 27 publications

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Prospective of 31P MR Spectroscopy in Hepatopancreatobiliary Cancer: A Systematic Review of the Literature

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Prospective of ³¹P MR Spectroscopy in Hepatopancreatobiliary Cancer: A Systematic Review of the Literature