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Pancreatic Resection for M1 Pancreatic Ductal Adenocarcinoma

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Abstract

Background

Improved safety of pancreatic surgery has led to consideration of more aggressive approaches, such as resection for primary pancreatic ductal adenocarcinoma (PDAC) with metastatic disease (M1).

Methods

A total of 29 patients who underwent pancreatic resection with resection of associated metastatic disease (interaortocaval lymph node dissection, liver resection, and/or multiorgan resections) were retrospectively identified from a database of 316 R0/R1 pancreatic resections for PDAC. An explorative data analysis of perioperative and clinicopathological parameters, and overall survival was performed by Kaplan-Meier estimation, log rank test, and Fisher’s exact test.

Results

The overall in-hospital mortality and morbidity of R0/R1 pancreatic resections for M1 disease (n = 29) was 0% and 24.1%, compared with 4.2% and 35.2% of R0/R1 pancreatic resections for M0 disease (n = 287). The median overall survival time was 13.8 months (95% confidence interval [CI], 11.4–20.5), and the estimated 1-year overall survival rate was 58.9% (95% CI, 34.8–76.7) for patients with M1 disease. The median survival in those with metastatic interaortocaval lymph nodes was 27 months (95% CI, 9.6–27.0), whereas it was 11.4 months (95% CI, 7.8–16.5) and 12.9 months (95% CI, 7.2–20.5) for those with liver and peritoneal metastases, respectively.

Conclusions

Pancreatic resections with M1 disease can be performed with acceptable safety in highly selected patients. The survival after interaortocaval lymph node resection is comparable to that of other lymph nodes that do not constitute M1 disease. Resection of liver and peritoneal metastases, although safe in this series, cannot be generally recommended until further controlled trials can be conducted.

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References

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56:106–30

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer 2001; 37(Suppl 8):S4–66

    Article  PubMed  Google Scholar 

  3. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94:153–6

    Article  PubMed  CAS  Google Scholar 

  4. Ozawa F, Friess H, Kunzli B, et al. Treatment of pancreatic cancer: the role of surgery. Dig Dis 2001; 19:47–56

    Article  PubMed  CAS  Google Scholar 

  5. Fernandez-del CC, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995; 130:295–9

    Google Scholar 

  6. Stojadinovic A, Hoos A, Brennan MF, Conlon KC. Randomized clinical trials in pancreatic cancer. Surg Oncol Clin N Am 2002; 11:207–29

    Article  PubMed  Google Scholar 

  7. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993; 217:430–5

    Article  PubMed  CAS  Google Scholar 

  8. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990; 211:447–58

    Article  PubMed  CAS  Google Scholar 

  9. Howard JM. Development and progress in resective surgery for pancreatic cancer. World J Surg 1999; 23:901–6

    Article  PubMed  CAS  Google Scholar 

  10. Picozzi VJ, Kozarek RA, Traverso LW. Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003; 185:476–80

    Article  PubMed  Google Scholar 

  11. Fortner JG. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg 1984; 199:418–25

    Article  PubMed  CAS  Google Scholar 

  12. Fortner JG. “Radical” abdominal cancer surgery: current state and future course. Jpn J Surg 1989; 19:503–9

    Article  PubMed  CAS  Google Scholar 

  13. Shoup M, Conlon KC, Klimstra D, Brennan MF. Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 2003; 7:946–52

    Article  PubMed  Google Scholar 

  14. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 1999; 229:613–22

    Article  PubMed  CAS  Google Scholar 

  15. Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 2003; 138:1316–22

    Article  PubMed  Google Scholar 

  16. Nguyen TC, Sohn TA, Cameron JL, et al. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg 2003; 7:1–9

    Article  PubMed  Google Scholar 

  17. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998; 228:508–17

    Article  PubMed  CAS  Google Scholar 

  18. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236:355–66

    Article  PubMed  Google Scholar 

  19. Van CE, Aerts R, Haustermans K, Topal B, Van SW, Verslype C. Systemic treatment of pancreatic cancer. Eur J Gastroenterol Hepatol 2004; 16:265–74

    Google Scholar 

  20. Smeenk HG, Tran TC, Erdmann J, van Eijck CH, Jeekel J. Survival after surgical management of pancreatic adenocarcinoma: does curative and radical surgery truly exist? Langenbecks Arch Surg 2005; 390:94–103

    Article  PubMed  CAS  Google Scholar 

  21. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004; 91:586–94

    Article  PubMed  CAS  Google Scholar 

  22. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann Surg 1995; 221:721–31

    Article  PubMed  CAS  Google Scholar 

  23. Neoptolemos JP, Stocken DD, Dunn JA, et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001; 234:758–68

    Article  PubMed  CAS  Google Scholar 

  24. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350:1200–10

    Article  PubMed  CAS  Google Scholar 

  25. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 2003; 27:324–9

    Article  PubMed  Google Scholar 

  26. Bassi C, Stocken DD, Olah A, et al. Influence of surgical resection and post-operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC-1 Randomized Controlled Trial. Dig Surg 2005; 22:353–63

    Article  PubMed  CAS  Google Scholar 

  27. Goldstein D, Carroll S, Apte M, Keogh G. Modern management of pancreatic carcinoma. Intern Med J 2004; 34:475–81

    Article  PubMed  CAS  Google Scholar 

  28. Koeppler H, Duru M, Grundheber M, et al. Palliative treatment of advanced pancreatic carcinoma in community-based oncology group practices. J Support Oncol 2004; 2:159–63

    PubMed  CAS  Google Scholar 

  29. Prost P, Ychou M, Azria D. [Gemcitabine and pancreatic cancer]. Bull Cancer 2002; 89(Spec No):S91–5

    PubMed  Google Scholar 

  30. Cunningham D, Chau I, Stocken D, et al. Phase III randomised comparison of gemcitabine (GEM) versus gemcitabine plus capecitabine (GEM-CAP) in patients with advanced pancreatic cancer. Eur J Cancer 2005; 3:4 (abstract PS11)

    Google Scholar 

  31. Moore MJ, Goldstein D, Hamm J, et al. Erlotinib improves survival when added to gemcitabine in patients with advanced pancreatic cancer. A phase III trial of the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG). J Clin Oncol 2005;ASCO Annual Meeting Proceedings. (abstract 77). Vol 23, No.16S, Part I of II (June 1 Supplement), 2005:1 41st Annual Meeting American Society of Clinical Oncology (ASCO) May 13–17, 2005 Orlando, Florida

  32. Yamada H, Katoh H, Kondo S, Okushiba S, Morikawa T. Hepatectomy for metastases from non-colorectal and non-neuroendocrine tumor. Anticancer Res 2001; 21:4159–62

    PubMed  CAS  Google Scholar 

  33. Christophe M, Le Treut YP, Pol B, Brandone JM, Capobianco C, Bricot R. [Cancer of the pancreas. A plea for resection. 162 operated patients]. Presse Med 1992; 21:741–4

    PubMed  CAS  Google Scholar 

  34. Lillemoe KD, Cameron JL, Yeo CJ, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg 1996; 223:718–25

    Article  PubMed  CAS  Google Scholar 

  35. Beger HG, Thorab FC, Liu Z, Harada N, Rau BM. Pathogenesis and treatment of neoplastic diseases of the papilla of Vater: Kausch-Whipple procedure with lymph node dissection in cancer of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004; 11:232–8

    Article  PubMed  Google Scholar 

  36. Pedrazzoli S, Pasquali C, Sperti C. General aspects of surgical treatment of pancreatic cancer. Dig Surg 1999; 16:265–75

    Article  PubMed  CAS  Google Scholar 

  37. Shimada K, Kosuge T, Yamamoto J, Yamasaki S, Sakamoto M. Successful outcome after resection of pancreatic cancer with a solitary hepatic metastasis. Hepatogastroenterology 2004; 51:603–5

    PubMed  Google Scholar 

  38. Sunada S, Miyata M, Tanaka Y, et al. Aggressive resection for advanced pancreatic carcinoma. Surg Today 1992; 22:74–7

    Article  PubMed  CAS  Google Scholar 

  39. Burris HA III, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15:2403–13

    PubMed  CAS  Google Scholar 

  40. Conroy T, Paillot B, Francois E, et al. Irinotecan plus oxaliplatin and leucovorin-modulated fluorouracil in advanced pancreatic cancer—a Groupe Tumeurs Digestives of the Federation Nationale des Centres de Lutte Contre le Cancer study. J Clin Oncol 2005; 23:1228–36

    Article  PubMed  CAS  Google Scholar 

  41. Van Cutsem E, van de Velde H, Karasek P, et al. Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol 2004; 22:1430–8

    Article  PubMed  CAS  Google Scholar 

  42. Cress RD, Yin D, Clarke L, Bold R, Holly EA. Survival among patients with adenocarcinoma of the pancreas: a population-based study (United States). Cancer Causes Control 2006; 17:403–9

    Article  PubMed  Google Scholar 

  43. Carpelan-Holmstrom M, Nordling S, Pukkala E, et al. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut 2005; 54:385–7

    Article  PubMed  CAS  Google Scholar 

  44. Connor S, Bosonnet L, Ghaneh P, et al. Survival of patients with periampullary carcinoma is predicted by lymph node 8a but not by lymph node 16b1 status. Br J Surg 2004; 91:1592–9

    Article  PubMed  CAS  Google Scholar 

  45. Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005; 138:618–28

    Article  PubMed  Google Scholar 

  46. Henne-Bruns D, Vogel I, Luttges J, Kloppel G, Kremer B. Ductal adenocarcinoma of the pancreas head: survival after regional versus extended lymphadenectomy. Hepatogastroenterology 1998; 45:855–66

    PubMed  CAS  Google Scholar 

  47. Nimura Y, Nagino M, Kato H, et al. Standard versus extended lymphadenectomy for pancreatic cancer: a multicenter, randomized controlled trial. Pancreatology 2004; 4:274

    Google Scholar 

  48. Klempnauer J, Ridder GJ, Piso P, Pichlmayr R. [Is liver resection in metastases of exocrine pancreatic carcinoma justified?]. Chirurg 1996; 67:366–70

    PubMed  CAS  Google Scholar 

  49. Louvet C, Labianca R, Hammel P, et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 2005; 23:3509–16

    Article  PubMed  CAS  Google Scholar 

  50. Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. An early phase II study of S-1 in patients with metastatic pancreatic cancer. Oncology 2005; 68:171–8

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400012, India

    Shailesh V. Shrikhande MD

  2. Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jörg Kleeff MD, Carolin Reiser MD, Jürgen Weitz MD, Ulf Hinz MSc, Jan Schmidt MD, Helmut Friess MD & Markus W. Büchler MD

  3. Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220, 69120, Heidelberg, Germany

    Irene Esposito MD

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  1. Shailesh V. Shrikhande MD
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  2. Jörg Kleeff MD
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Correspondence to Markus W. Büchler MD.

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S.V.S. and J.K. contributed equally to this article.

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Shrikhande, S.V., Kleeff, J., Reiser, C. et al. Pancreatic Resection for M1 Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 14, 118–127 (2007). https://doi.org/10.1245/s10434-006-9131-8

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  • DOI: https://doi.org/10.1245/s10434-006-9131-8

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