Oncological Role of Surgical Resection in Patients with Pancreatic Ductal Adenocarcinoma with Liver-only Synchronous Metastases in a Single-center Retrospective Study

Overview

Journal J Gastrointest Oncol

Date 2024 Jan 10

PMID 38196535

Authors

Sohei Satoi

Tomohisa Yamamoto

Daisuke Hashimoto

So Yamaki

Yuki Matsui

Tsukasa Ikeura

Shogen Boku

Nobuhiro Shibata

Denys Tsybulskyi

Mitsugu Sekimoto

Affiliations

Soon will be listed here.

Abstract

Background: Surgical resection for liver-only synchronous metastases of pancreatic ductal adenocarcinoma remains controversial. We investigated the role of conversion surgery in patients with a favorable response to systemic chemotherapy.

Methods: Patients (n=49) were diagnosed liver-only synchronous metastases using staging laparoscopy or open laparotomy between 2007 and 2022. Clinical outcomes were retrospectively compared among patients who underwent conversion surgery (n=10), upfront surgery with or without short-term neoadjuvant chemotherapy (UpS/short NAC) for oligometastases and occult metastases limited to the liver (n=8), and chemotherapy only for resectable or borderline resectable disease with occult liver-only metastases (n=31). The surgical indication of conversion surgery was fixed as the ABC criteria, namely, Anatomical objective response of disappearance of liver metastases on imaging studies, Biological response of CA19-9 level decrease to ≤150 U/mL, and Conditional response of surgical fitness. In addition to the above ABC criteria, tumor disappearance at the liver was repeatedly confirmed using staging laparoscopy (laparoscopic response; L), and metabolic complete responses were confirmed using positron emission tomography-computed tomography (CT) (metabolic response; M).

Results: Median survival time from initial treatment was 9.9 months [95% confidence interval (CI): 8.3-10.9] in the chemotherapy group, 10.4 months (95% CI: 6.6-17.8) in the UpS/short NAC group, and 36.7 months (95% CI: 19.0-84.8) in the conversion surgery group (conversion surgery UpS/short NAC, P=0.002; conversion surgery chemotherapy, P<0.001; UpS/short NAC chemotherapy, P=0.554). One patient in the UpS/short NAC group and three in the conversion surgery group achieved 5-year survival. Among them, two patients with initially multiple liver metastases (≥10) in the conversion surgery group survived beyond 5 years. Only conversion surgery was a significant independent prognostic factor in a total cohort (hazard ratio; 0.173, P=0.002).

Conclusions: Conversion surgery, but not UpS/short NAC, may enhance survival in patients with synchronous liver metastases and favorably anatomical, biological and conditional responses to systemic chemotherapy.

Citing Articles

Conversion surgery for BRCA-mutated pancreatic ductal adenocarcinoma with liver metastasis treated with platinum-based chemotherapy followed by olaparib.

Funo T, Hashimoto D, Yamaki S, Matsumura K, Miyazaki H, Matsui Y Surg Case Rep. 2024; 10(1):179.

PMID: 39078424 PMC: 11289193. DOI: 10.1186/s40792-024-01975-x.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Yanagimoto H, Satoi S, Yamamoto T, Yamaki S, Hirooka S, Kotsuka M . Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma. Cancers (Basel). 2020; 12(6). PMC: 7352934. DOI: 10.3390/cancers12061428. View

Sakaguchi T, Satoi S, Hashimoto D, Yamamoto T, Yamaki S, Hirooka S . A simple risk score for detecting radiological occult metastasis in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma. J Hepatobiliary Pancreat Sci. 2021; 29(2):262-270. DOI: 10.1002/jhbp.1026. View

Isaji S, Mizuno S, Windsor J, Bassi C, Fernandez-Del Castillo C, Hackert T . International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology. 2017; 18(1):2-11. DOI: 10.1016/j.pan.2017.11.011. View

Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y . FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19):1817-25. DOI: 10.1056/NEJMoa1011923. View

Crippa S, Bittoni A, Sebastiani E, Partelli S, Zanon S, Lanese A . Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy?. Eur J Surg Oncol. 2016; 42(10):1533-9. DOI: 10.1016/j.ejso.2016.06.398. View

Shrikhande S, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I . Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2006; 14(1):118-27. DOI: 10.1245/s10434-006-9131-8. View

Toiyama Y, Miki C, Inoue Y, Tanaka K, Mohri Y, Kusunoki M . Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med. 2012; 2(1):95-101. PMC: 3440627. DOI: 10.3892/etm.2010.175. View

Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N . Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013; 31(13):1640-8. DOI: 10.1200/JCO.2012.43.3680. View

10.

Onodera T, Goseki N, KOSAKI G . [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984; 85(9):1001-5. View

11.

Von Hoff D, Ervin T, Arena F, Chiorean E, Infante J, Moore M . Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013; 369(18):1691-703. PMC: 4631139. DOI: 10.1056/NEJMoa1304369. View

12.

Guckenberger M, Lievens Y, Bouma A, Collette L, Dekker A, deSouza N . Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020; 21(1):e18-e28. DOI: 10.1016/S1470-2045(19)30718-1. View

13.

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003; 89(6):1028-30. PMC: 2376960. DOI: 10.1038/sj.bjc.6601242. View

14.

Frigerio I, Malleo G, De Pastena M, Deiro G, Surci N, Scopelliti F . Prognostic Factors After Pancreatectomy for Pancreatic Cancer Initially Metastatic to the Liver. Ann Surg Oncol. 2022; 29(13):8503-8510. PMC: 9383677. DOI: 10.1245/s10434-022-12385-4. View

15.

Frigerio I, Regi P, Giardino A, Scopelliti F, Girelli R, Bassi C . Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?. Ann Surg Oncol. 2017; 24(8):2397-2403. DOI: 10.1245/s10434-017-5885-4. View

16.

Hank T, Klaiber U, Hinz U, Schutte D, Leonhardt C, Bergmann F . Oncological Outcome of Conversion Surgery After Preoperative Chemotherapy for Metastatic Pancreatic Cancer. Ann Surg. 2022; 277(5):e1089-e1098. PMC: 10082047. DOI: 10.1097/SLA.0000000000005481. View

17.

Hashimoto D, Sakaguchi T, Satoi S, Yamamoto T, Yamaki S, Ishida M . Survival impact of occult liver metastasis and peritoneal dissemination compared with radiologically defined distant organ metastasis in pancreatic ductal adenocarcinoma. Pancreatology. 2022; 23(1):73-81. DOI: 10.1016/j.pan.2022.11.012. View

18.

Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S . Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of.... J Hepatobiliary Pancreat Sci. 2013; 20(6):590-600. DOI: 10.1007/s00534-013-0616-0. View

19.

Hackert T, Niesen W, Hinz U, Tjaden C, Strobel O, Ulrich A . Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2016; 43(2):358-363. DOI: 10.1016/j.ejso.2016.10.023. View

20.

Satoi S, Yamamoto T, Yamaki S, Sakaguchi T, Sekimoto M . Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg. 2020; 4(1):6-13. PMC: 6992681. DOI: 10.1002/ags3.12295. View