Dose surgical resection of hepatic metastases bring benefits to pancreatic ductal adenocarcinoma? A systematic review and meta-analysis

Yu, Xinzhe; Gu, Jichun; Fu, Deliang; Jin, Chen

doi:10.1016/j.ijsu.2017.10.066

Cited by 25 publications

(23 citation statements)

References 26 publications

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“…According to a systematic review and meta‐analysis, hepatectomy for liver metastasis arising from pancreatic cancer did not yield favorable outcomes; 3‐year and 5‐year survival rates were only 13.3% and 2.9%, respectively . Among our study patients, 5‐year overall survival after hepatectomy was 31%, with a median survival time of 26 months.…”

Section: Discussionmentioning

confidence: 63%

Outcomes of 1,639 hepatectomies for non‐colorectal non‐neuroendocrine liver metastases: a multicenter analysis

Sano

Yamamoto

Mimura

et al. 2018

J Hepato Biliary Pancreat

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Background Whether non‐colorectal non‐neuroendocrine liver metastasis (NCNNLM) should be treated surgically remains unclear. Methods Data regarding 1,639 hepatectomies performed between 2001 and 2010 for 1,539 patients with NCNNLM were collected from 124 institutions. Patient characteristics, types of primary tumor, characteristics of liver metastases, and post‐hepatectomy outcomes were analyzed. Results The five most frequent primary tumors were gastric carcinoma (540 patients [35%]), gastrointestinal stromal tumor (204 patients [13%]), biliary carcinoma (150 patients [10%]), ovarian cancer (107 patients [7%]), and pancreatic carcinoma (77 patients [5%]). R0/1 hepatectomy was achieved in 90% of patients, with 1.5% in‐hospital mortality rate. Overall and disease‐free survival rates of 1,465 patients included in survival analysis were 41% and 21%, respectively, at 5 years, and 28% and 15%, respectively, at 10 years. Five‐year survival associated with the five frequent primary tumors were 32%, 72%, 17%, 52%, and 31%, respectively, and factors predictive of a poor outcome differed by the primary tumor type. Conclusions Our data indicated that hepatectomy is safe for NCNNLM and that patient prognoses vary depending on the type of primary tumors. Indications for hepatectomy should be determined with reference to survival rates and risk factors specific to each of the various types of primary tumor.

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Section: Discussionmentioning

confidence: 63%

Outcomes of 1,639 hepatectomies for non‐colorectal non‐neuroendocrine liver metastases: a multicenter analysis

Sano

Yamamoto

Mimura

et al. 2018

J Hepato Biliary Pancreat

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“…Pancreatic cancer is a kind of systematic disease with complex genetic and epigenetic alternations 31 , 32 . Few patients with pancreatic cancer are cured even after radical-intended resection, and up to 80% patients suffered intrahepatic metastases no more than 2 years 33 . Over the past decades, our knowledge of cancer has increased exponentially, however the understanding of tumor metastases remains poor, especially for pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Detection of CTCs in portal vein was associated with intrahepatic metastases and prognosis in patients with advanced pancreatic cancer

Liu

et al. 2018

J. Cancer

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Pancreatic cancer is amongst the most lethal malignancies with increasing incidence and mortality worldwide. Distant metastases, especially intrahepatic metastases, is the leading cause of death for pancreatic cancer. Circulating tumor cells (CTCs) are neoplastic cells released from the primary tumor into circulation, and play critical roles in metastases of various types of cancers. Though clinical studies showed that detection of CTCs in peripheral circulation was associated with worse prognosis in patients with breast cancer and hepatocellular carcinoma, detection CTCs in peripheral blood of pancreatic cancer was still challenging due to hepatic filtration and technical limitations. Previous studies have demonstrated that CTCs could be detected in portal vein circulation in patients with pancreaticobiliary carcinoma. In the present study, taking advantage of ultrasonography-guided transhepatic puncture, we analysis CTCs in portal vein blood obtained from patients with advanced pancreatic cancer. CTCs were detected in all 29-portal vein blood of samples, and absolute numbers of circulating pancreatic cancer cells in portal vein was significantly higher than that in peripheral circulation. Furthermore, we found that CTC counts in portal vein was highly associated with intrahepatic metastases and indicated poorer prognosis in patients with advanced pancreatic cancer. Short-term expansion and in vitro drug sensitivity assay showed that CTCs derived from portal vein blood were highly resistant to several chemotherapy regimens. In summary, detection of CTCs in portal vein could be a powerful tool to stratify the risk of intrahepatic metastases of pancreatic cancer, and provided new insight into the biological feature of pancreatic cancer metastases and drug resistance.

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“…For the surgical group, the median 1-year, 3-year and 5-year survival rates was 40.9, 13.3, and 2.9%, respectively, with a median survival of 9.9 months. Surgical resection of hepatic metastases was associated with significantly improved overall 1-year and 3-year survival (p < 0.001) [10].…”

Section: Discussionmentioning

confidence: 96%

Searching for novel multimodal treatments in oligometastatic pancreatic cancer

et al. 2020

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Background: Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. Case presentation: We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/ mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. Conclusions: Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

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Dose surgical resection of hepatic metastases bring benefits to pancreatic ductal adenocarcinoma? A systematic review and meta-analysis

Abstract: Hepatic resection is a safe procedure; furthermore, it is worth doing such an extended surgery for PDAC patients due to additional survival benefit in the medium-term (less than 3 years). However, further randomized, controlled trials are urgently needed.

Cited by 25 publications

References 26 publications

Outcomes of 1,639 hepatectomies for non‐colorectal non‐neuroendocrine liver metastases: a multicenter analysis

Outcomes of 1,639 hepatectomies for non‐colorectal non‐neuroendocrine liver metastases: a multicenter analysis

Detection of CTCs in portal vein was associated with intrahepatic metastases and prognosis in patients with advanced pancreatic cancer

Searching for novel multimodal treatments in oligometastatic pancreatic cancer

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