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

Antoniou, Efstathios; Margonis, Georgios Antonios; Sasaki, Kazunari; Andreatos, Nikolaos; Polychronidis, Georgios; Pawlik, Timothy M.; Pikoulis, Emmanouil

doi:10.1111/ans.13738

Cited by 24 publications

(24 citation statements)

References 23 publications

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“…The feasibility and safety of combined pancreatectomies and liver resections has been already demonstrated (95). Actually most patients resected for M1 liver PDAC reported in the literature underwent wedge/atypical only liver resections (96)(97)(98).…”

Section: Resection For M1 Pdacmentioning

confidence: 99%

“…Interestingly, a recent multicentric study has shown that the overall survival is significantly higher in patients with oligometastatic M1 PDAC of the head who underwent resection, compared with bypass, while for M1 PDAC of the body and tail no differences were observed (102). Recent reviews of the literature have shown that resection for M1 liver PDAC might have a survival benefit in carefully selected patients, particularly with metachronous metastases (96,98).…”

Section: Resection For M1 Pdacmentioning

confidence: 99%

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Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Section: Resection For M1 Pdacmentioning

confidence: 99%

Section: Resection For M1 Pdacmentioning

confidence: 99%

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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“…Approximately 49.5% of patients present distant metastases at the time of a pancreatic cancer diagnosis. The median OS of metastatic pancreatic ductal adenocarcinoma (PDAC) is less than 12 months if treated with chemotherapy [1].…”

Section: Introductionmentioning

confidence: 99%

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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“…The primary cause of death for patients with pancreatic adenocarcinoma is metastatic disease rather than local recurrence. Antoniou et al have shown that pancreatic metastasectomy can now be undertaken safely but also that hepatic resection is not enough to ensure cure. The results of the ACCORD 11 trial confirm that FOLFIRINOX is active against pancreatic adenocarcinoma and that discussion should commence around criteria to select patients in whom hepatic resection or ablation might be offered.…”

mentioning

confidence: 99%

“…The results of the ACCORD 11 trial confirm that FOLFIRINOX is active against pancreatic adenocarcinoma and that discussion should commence around criteria to select patients in whom hepatic resection or ablation might be offered. As Antoniou et al point out in their final paragraph, approaches historically based on solitary or unilobar disease have met success for metastatic colorectal cancer, and neuroendocrine, non‐colorectal, and non‐neuroendocrine tumours. More recently, biological selection based on a favourable response to systemic therapy has been employed for these tumour types either by standard cross‐sectional or functional imaging.…”

mentioning

confidence: 99%