Preoperative evaluation of pancreatic ductal adenocarcinoma with synchronous liver metastasis: Diagnosis and assessment of unresectability

Abstract

AIMTo identify predictors for synchronous liver metastasis from resectable pancreatic ductal adenocarcinoma (PDAC) and assess unresectability of synchronous liver metastasis.METHODSRetrospective records of PDAC patients with synchronous liver metastasis who underwent simultaneous resections of primary PDAC and synchronous liver metastasis, or palliative surgical bypass, were collected from 2007 to 2015. A series of pre-operative clinical parameters, including tumor markers and inflammation-based indices, were analyzed by logistic regression to figure out predictive factors and assess unresectability of synchronous liver metastasis. Cox regression was used to identify prognostic factors in liver-metastasized PDAC patients after surgery, with intention to validate their conformance to the indications of simultaneous resections and palliative surgical bypass. Survival of patients from different groups were analyzed by the Kaplan-Meier method. Intra- and post-operative courses were compared, including complications. PDAC patients with no distant metastases who underwent curative resection served as the control group.RESULTSCA125 > 38 U/mL (OR = 12.397, 95%CI: 5.468-28.105, P < 0.001) and diabetes mellitus (OR = 3.343, 95%CI: 1.539-7.262, P = 0.002) independently predicted synchronous liver metastasis from resectable PDAC. CA125 > 62 U/mL (OR = 5.181, 95%CI: 1.612-16.665, P = 0.006) and age > 62 years (OR = 3.921, 95%CI: 1.217-12.632, P = 0.022) correlated with unresectability of synchronous liver metastasis, both of which also indicated a worse long-term outcome of liver-metastasized PDAC patients after surgery. After the simultaneous resections, patients with post-operatively elevated serum CA125 levels had shorter survival than those with post-operatively reduced serum CA125 levels (7.7 mo vs 16.3 mo, P = 0.013). The survival of liver-metastasized PDAC patients who underwent the simultaneous resections was similar to that of non-metastasized PDAC patients who underwent curative pancreatectomy alone (7.0 mo vs 16.9 mo, P < 0.001), with no higher rates of either pancreatic fistula (P = 0.072) or other complications (P = 0.230) and no greater impacts on length of hospital stay (P = 0.602) or post-operative diabetic control (P = 0.479).CONCLUSIONThe criterion set up by CA125 levels could facilitate careful diagnosis of synchronous liver metastases from PDAC, and prudent selection of appropriate patients for the simultaneous resections.

Clinical outcome after liver resection for colorectal versus non-colorectal metastasis: a comparative study

“…16 Simultaneous pancreatico-duodenectomy (Whipple procedure) and resection of liver metastasis from pancreatic head cancer was reported to be not associated with increased postoperative complications. 17 We reported on two cases of pancreatico-duodenectomy and segmental liver resection owing to uncertain diagnosis by preoperative imaging and lack of intra-operative frozen section biopsy. In both patients, pancreatic metastasis was confirmed on postoperative histopathological examination.…”

Cáncer de páncreas. Epidemiología de su mal pronóstico

“…Es interesante destacar que la localización más frecuente de la enfermedad metastásica fue a nivel hepático (92%), lo cual difiere de la literatura internacional en que es alrededor de 50% (9) . La aparición tardía de los síntomas hace que solo entre 10% y 20% (4)(5)(6) de los pacientes se presenten con una enfermedad pasible de una resección quirúrgica al momento del diagnóstico.…”

“…El 80% de estos son adenocarcinomas acinares (2) , la mayoría de localización cefálica (3) . Con baja resecabilidad (4)(5)(6) (10% a 20%), vinculada a una estricta selección preoperatoria en base a estudios imagenológicos así como a la laparoscopía estadificadora (7) . En nuestro medio al momento de su diagnóstico la mayoría de los pacientes son candidatos a la paliación de sus síntomas por presentar elementos de irresecabilidad o incurabilidad.…”

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

“…However, no high-level evidence via prospective trials or meta-analyses has been generated on this topic to date, as studies are ongoing [23]. Also, biomarkers or clinical factors guiding treatment algorithms are not well defined [24]. The present narrative literature review summarizes available oncosurgical reports on potentially resectable oligometastatic PC and compares these outcomes with other local treatments such as liver-directed stereotactic body radiotherapy (SBRT), selective internal radiation therapy (SIRT), or radiofrequency ablation (RFA; [25,26]) to propose a treatment algo-…”