“…A comparable dominance of the systemic hematogenous pathway was also documented in the reports detailing the fate of patients after successful isPM surgery. Of 116 metachronous metastases (6, 16, 28, 35, 47, 57, 58, 69, 70, 72, 74, 82, 84-86, 90, 94, 108, 112, 118, 123, 126, 128, 136, 139-141, 149, 159, 160, 166, 168, 173, 175, 176, 178, 180, 181, 183, 187, 198, 203, 204, 218) 76.7% were undoubtedly of systemic hematogenous origin and in no more than 23.3% of the cases, a local pathway had to be taken into consideration (72,84,108,139,140,160,166,175,180,181,183,187,198). In sum, for metastases that occurred both before and after pancreatic surgery those attributable to a systemic hematogenous spread predominated.…”