The Impact of Simultaneous Liver Resection for Occult Liver Metastases of Pancreatic Adenocarcinoma

Abstract

Backround. Pancreas resection is the only curative treatment for pancreatic adenocarcinoma. In the event of unexpected incidental liver metastases during operative exploration patients were traditionally referred to palliative treatment arms. With continuous progress in the surgical expertise simultaneous pancreas and liver resections seem technically feasible nowadays. The aim of this study therefore was to analyze the impact of synchronous liver-directed therapy on operative outcome and overall survival in patients with hepatic metastasized pancreatic adenocarcinoma (HMPA). Methods. 22 patients who underwent simultaneous pancreas resection and liver-directed therapy for HMPA between January 1, 2004 and January 1, 2009 were compared to 22 patients who underwent classic pancreas resection for nonmetastasized pancreatic adenocarcinoma (NMPA) in a matched pair study design. Postoperative morbidity, preoperative, and operative data and overall survival were analyzed. Results. Overall survival was significantly decreased in the HMPA group. Postoperative morbidity and mortality and median operation time did not significantly differ between the groups. Conclusion. The results of our study showed that simultaneous pancreas resection and liver-directed therapy may safely be performed and may therefore be applied in individual patients with HMPA. However, a potential benefit of this radical surgical approach with regard to overall survival and/or quality of life remains to be proven.

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

“…However, resection for metachronous liver metastases instead of gemcitabine might extend survival in highly selected patients. Meanwhile, Klein et al[50] reported that no similar survival was achieved by pancreatectomy and simultaneous liver resection for PDAC, albeit at a R0 status, compared with pancreatectomy for non-metastasized PDAC (13.0 mo vs 26.5 mo)[50] (Table 8). On the contrary, we showed that the survival of PDAC patients with synchronous liver metastasis who underwent simultaneous curative resections (15.7 mo) was not only longer than that of those who underwent palliative surgical bypass alone (4.4 mo) but also similar to that of patients with non-metastasized PDAC who underwent curative pancreatectomy alone (16.9 mo).…”

Oligometastatic Disease in Pancreatic Cancer - How to Proceed

“…However, published data demonstrate that the procedure can be performed safely, but results are inconsistent as to whether complete resection of the PDAC with combined resection of liver metastases will lead to a survival benefit [30,[38][39][40][41][42][43]. Eight reports including more than 9 patients found median overall survival times between 5.9 and 11.4 months after resection [29,39,42,[44][45][46][47][48].…”

“…Klein et al [44] reported a median survival in PDAC patients with hepatic metastases of 7.6 months after resection. Within this small study, 22 PDAC patients who underwent synchronous, liverdirected therapy either with anatomical liver resection (7 patients (32%)) or atypical resection (15 patients (68%)) were analyzed.…”

Is resection of pancreatic adenocarcinoma with synchronous hepatic metastasis justified? A review of current literature

“…In 2012, another study from Germany, this time from the Charite group, compared the outcomes of 22 patients who underwent simultaneous pancreas resection and liver‐directed therapy for pancreatic adenocarcinoma with 22 patients who underwent standard pancreatectomy for non‐metastasized PDAC in a matched pair study design . Although postoperative morbidity (≥Clavien 3) was higher in the LM group, the result was not statistically significant ( P = 0.099).…”

“…Klein et al . compared patients who underwent resection of PDAC and associated LM with those who only underwent standard pancreatectomy . In 2010, Seelig et al .…”