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International Journal of Clinical Oncology

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Open Access 01-10-2021 | Metastasis | Original Article

Surgical margin clearance and extended chemotherapy defines survival for synchronous oligometastatic liver lesions of the ductal adenocarcinoma of the pancreas

Authors: S. A. Safi, G. Fluegen, A. Rehders, L. Haeberle, S. Fung, V. Keitel, A. Krieg, W. T. Knoefel, N. Lehwald-Tywuschik

Published in: International Journal of Clinical Oncology | Issue 10/2021

Abstract

Background

The role of surgery for circumscribed synchronous hepatic lesions of the pancreatic ductal adenocarcinoma (PDAC) remains controversial. Thus, the aim of our study was to compare survival outcome (OS) after surgery of patients with hepatic metastases (M1surg) to patients with only localized disease.

Methods

Correlation analysis of clinicopathological data and OS after resection of M1surg patients and patients with localized PDACs (M0) was performed. Patients were included for survival analysis only if a complete staging including perineural, venous and lymphatic invasion was available.

Results

Out of the study collective, 35 patients received extended surgery (M1surg), whereas 131 patients received standardized surgery for localized disease (M0). Length of hospitalization and mortality was similar in both groups. FOLFIRNOX as an adjuvant treatment regime was administered in ~ 23 and ~ 8% of M1surg and M0 patients, respectively. In subgroup analysis of R0 resected patients and in multivariate analysis of the total cohort, there was no difference in overall survival between both groups. Only the resection status (R1 vs R0) and venous invasion (V1) were identified as independent prognostic factors. Site of recurrence in R0 resected M1surg patients and in M0 patients were homogenously distributed.

Conclusion

This is the first study demonstrating a survival benefit after extended surgery for synchronously hepatic-metastasized PDACs. We found no difference in survival outcome of metastasized patients when compared to patients with localized disease. FOLFIRINOX as an adjuvant treatment regime for resected M1surg presumably is worthwhile. Larger multicenter studies are still needed to validate our results.

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Rahib L, Smith BD, Aizenberg R et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Can Res 74(11):2913–2921CrossRef

Quante AS, Ming C, Rottmann M et al (2016) Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030. Cancer Med 5(9):2649–2656CrossRef

Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297(3):267–277CrossRef

Neoptolemos JP, Palmer DH, Ghaneh P et al (2017) Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet (London, England) 389(10073):1011–1024CrossRef

Siegel RL, Miller KD, Jemal A (2020) Cancer statistics 2020. CA A Cancer J Clin 70(1):7–30CrossRef

Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371(22):2140–2141PubMed

Werner J, Combs SE, Springfeld C et al (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10(6):323–333CrossRef

Heinemann V, Haas M, Boeck S (2012) Systemic treatment of advanced pancreatic cancer. Cancer Treat Rev 38(7):843–853CrossRef

Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825CrossRef

10.

Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703CrossRef

11.

Smits FJ, van Santvoort HC, Besselink MG et al (2017) Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg 152(6):540–548CrossRef

12.

Seufferlein T, Porzner M, Becker T et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440CrossRef

13.

Primrose JN (2002) Treatment of colorectal metastases: surgery, cryotherapy, or radiofrequency ablation. Gut 50(1):1–5CrossRef

14.

Weitz J, Koch M, Debus J et al (2005) Colorectal cancer. Lancet (London, England) 365(9454):153–165CrossRef

15.

Zhou W, Wang D, Lou W (2020) Current Role Of Surgery In Pancreatic Cancer With Synchronous Liver Metastasis. Cancer control : Journ Moffitt Cancer Center 27(1):1073274820976593

16.

Hackert T, Niesen W, Hinz U et al (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol : J Eur Soc Surg Oncol British Assoc Surg Oncol 43(2):358–363CrossRef

17.

Dunschede F, Will L, von Langsdorf C, Mohler M et al (2010) Treatment of metachronous and simultaneous liver metastases of pancreatic cancer. Eur Surg Res 44(3–4):209–213CrossRef

18.

Tachezy M, Gebauer F, Janot M et al (2016) Synchronous resections of hepatic oligometastatic pancreatic cancer: Disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery 160(1):136–144CrossRef

19.

Gleisner AL, Assumpcao L, Cameron JL et al (2007) Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 110(11):2484–2492CrossRef

20.

Klempnauer J, Ridder GJ, Piso P et al (1996) Is liver resection in metastases of exocrine pancreatic carcinoma justified? Der Chirurg Zeitschrift fur alle Gebiete der operativen Medizen 67(4):366–370PubMed

21.

Moletta L, Serafini S, Valmasoni M et al (2019) Surgery for recurrent pancreatic cancer: is it effective? Cancers 11(7):991CrossRef

22.

Conroy T, Hammel P, Hebbar M et al (2018) FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 379(25):2395–2406CrossRef

23.

Schneitler S, Kröpil P, Riemer J et al (2015) Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection. World J Gastroenterol 21(20):6384–6390CrossRef

24.

Yachida S, White CM, Naito Y et al (2012) Clinical significance of the genetic landscape of pancreatic cancer and implications for identification of potential long-term survivors. Clin Cancer Res: Off J Am Assoc Cancer Res 18(22):6339–6347CrossRef

25.

Jones S, Zhang X, Parsons DW et al (2008) Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science 321(5897):1801–1806CrossRef

26.

Bailey P, Chang DK, Nones K et al (2016) Genomic analyses identify molecular subtypes of pancreatic cancer. Nature 531(7592):47–52CrossRef

Title: Surgical margin clearance and extended chemotherapy defines survival for synchronous oligometastatic liver lesions of the ductal adenocarcinoma of the pancreas
Authors: S. A. Safi
G. Fluegen
A. Rehders
L. Haeberle
S. Fung
V. Keitel
A. Krieg
W. T. Knoefel
N. Lehwald-Tywuschik
Publication date: 01-10-2021
Publisher: Springer Singapore
Keywords: Metastasis
Cytostatic Therapy
Published in: International Journal of Clinical Oncology / Issue 10/2021
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-021-01961-5

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