Resection of pancreatic ductal adenocarcinoma with synchronous distant metastasis: is it worthwhile?

Emmanuel Buc, David Orry, Olivier Antomarchi, Johan Gagnière, David Da Ines, Denis Pezet, Emmanuel Buc, David Orry, Olivier Antomarchi, Johan Gagnière, David Da Ines, Denis Pezet

Abstract

Background: The purpose of this study is to report prolonged survival in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) managed by chemotherapy and surgery.

Methods: Between January 2009 and August 2013, 284 patients with metastatic PDAC were managed in our oncologic department. Among them, three (1%) with a single metastasis (liver in two cases and interaorticaval in one case) underwent one- or two-stage surgical resection of the metastasis and the main tumor. Perioperative data were recorded retrospectively, including disease-free and overall survival.

Results: The three patients had chemotherapy (FOLFOX or FOLFIRINOX regimen) with objective response or stable disease prior to surgery. Median time between chemotherapy and surgery was 9 (8 to 15) months. Resection consisted in pancreaticoduodenectomy in the three cases. None of the patients had grade III/IV postoperative complications, and median hospital stay was 12 (12 to 22) days. All the patients had postoperative chemotherapy. Only one patient experienced recurrence 11 months after surgery and died after 32.5 months. The two other patients were alive with no recurrence 26.3 and 24.7 months after initial treatment.

Conclusion: Radical resection of PDAC with single distant metastases can offer prolonged survival with low morbidity after accurate selection by neoadjuvant chemotherapy.

Figures

Figure 1
Figure 1
Computed tomography (CT) scan of patient number 1 showing a tumor of the head of the pancreas (T) with infiltration of both the superior mesenteric vein (SMV) (white arrow) and the superior mesenteric artery (SMA) (yellow arrow). (A) Axial view; (B) frontal view; (C) sagittal view.
Figure 2
Figure 2
Computed tomography (CT) scan of patient number 2 before the initial palliative bypass procedure (A) showing a huge tumor of the head of the pancreas (T) with tumoral infiltration of both superior mesenteric vein (SMV) (white arrow) and superior mesenteric artery (SMA) (yellow arrow). Following six cycles of FOLFIRINOX chemotherapy and bypass procedure, the CT scan showed regression of the infiltration of the SMA with no detectable metastases (B).
Figure 3
Figure 3
Computed tomography (CT) scan of patient number 3 before initial palliative bypass procedure showing a tumor of the head of the pancreas (T) with lack of invasion of superior mesenteric vein (SMV) (white arrow) and superior mesenteric artery (SMA) (yellow arrow) (A) but unrecognized subcapsular liver metastases (white arrow) (B).

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Source: PubMed

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