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Pancreatic cancer and liver metastases: state of the art

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Abstract

Pancreatic cancer is still one of the most aggressive oncological diseases with a 5-year mortality rate below 10%. Surgery remains the only curative treatment; however, most patients present with late-stage disease deemed unresectable, either due to extensive local vascular involvement or the presence of distant metastasis. In the detection of hepatic metastases, the current standard is palliative chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) or nab-paclitaxel with gemcitabine. Once hepatic metastases are diagnosed, the guidelines do not recommend resection of the primary tumor. Recent findings suggest that some patients with non-resectable diseases initially have survival rates as good as those with initially resectable disease when they are able to undergo surgical resection. Synchronous resection of both the primary tumour as well as the liver metastases may be beneficial and improves the outcome.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825

    Article  CAS  PubMed  Google Scholar 

  3. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25:1960–1966

    Article  CAS  PubMed  Google Scholar 

  4. Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51:1395–1440

    Article  CAS  PubMed  Google Scholar 

  5. Tempero MA, Malafa MP, Behrman SW, Benson AB 3rd, Casper ES, Chiorean EG et al (2014) Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 12:1083–1093

    CAS  PubMed  Google Scholar 

  6. Tachezy M, Gebauer F, Petersen C, Arnold D, Trepel M, Wegscheider K et al (2014) Sequential neoadjuvant chemoradiotherapy (CRT) followed by curative surgery vs. primary surgery alone for resectable, non-metastasized pancreatic adenocarcinoma: NEOPA—a randomized multicenter phase III study (NCT01900327, DRKS00003893, ISRCTN82191749). BMC Cancer 14:411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA et al (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988

    Article  PubMed  Google Scholar 

  8. Tachezy M, Bockhorn M, Gebauer F, Vashist YK, Kaifi JT, Izbicki JR (2011) Bypass surgery versus intentionally incomplete resection in palliation of pancreatic cancer: is resection the lesser evil? J Gastrointest Surg 15:829–835

    Article  PubMed  Google Scholar 

  9. Burdelski CM, Reeh M, Bogoevski D, Gebauer F, Tachezy M, Vashist YK et al (2011) Multivisceral resections in pancreatic cancer: identification of risk factors. World J Surg 35:2756–2763

    Article  PubMed  Google Scholar 

  10. Bockhorn M, Burdelski C, Bogoevski D, Sgourakis G, Yekebas EF, Izbicki JR (2011) Arterial en bloc resection for pancreatic carcinoma. Br J Surg 98:86–92

    Article  CAS  PubMed  Google Scholar 

  11. Bockhorn M, Cataldegirmen G, Kutup A, Marx A, Burdelski C, Vashist JK et al (2009) Crossing the Rubicon: when pancreatic resection with curative intent ends in an R2 status. Impact of “desmoplastic pseudo-pancreatitis” and anatomical site of irresectability. Ann Surg Oncol 16:1212–1221

    Article  PubMed  Google Scholar 

  12. Michalski CW, Erkan M, Huser N, Muller MW, Hartel M, Friess H et al (2008) Resection of primary pancreatic cancer and liver metastasis: a systematic review. Dig Surg 25:473–480

    Article  PubMed  Google Scholar 

  13. Klein F, Puhl G, Guckelberger O, Pelzer U, Pullankavumkal JR, Guel S et al (2012) The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastro-enterol Res Pract 2012:939350

    CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  15. Sultana A, Smith CT, Cunningham D, Starling N, Neoptolemos JP, Ghaneh P (2007) Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25:2607–2615

    Article  PubMed  Google Scholar 

  16. Moore MJ, Goldstein D, Hamm J et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25:1960–1966

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  18. Hu J, Zhao G, Wang HX, et al (2011) A meta-analysis of gemcitabine containing chemotherapy for locally advanced and metastatic pancreatic adenocarcinoma. Journal of Hematology and Oncology

  19. Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF, Deshpande V et al (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg 257:731–736

    Article  PubMed  Google Scholar 

  20. Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M et al (2014) Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery 156:1–14

    Article  PubMed  Google Scholar 

  21. Stein A, Bokemeyer C (2014) How to select the optimal treatment for first line metastatic colorectal cancer. World J Gastroenterol 20(899–907):33

    Google Scholar 

  22. Pawlik TM, Vauthey JN, Abdalla EK, Pollock RE, Ellis LM, Curley SA (2006) Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg 141:537–543

    Article  PubMed  Google Scholar 

  23. Shrikhande SV, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I et al (2007) Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 14:118–127

    Article  PubMed  Google Scholar 

  24. Yamada S, Fujii T, Sugimoto H, Kanazumi N, Kasuya H, Nomoto S et al (2009) Pancreatic cancer with distant metastases: a contraindication for radical surgery? Hepatogastroenterology 56:881–885

    PubMed  Google Scholar 

  25. Klempnauer J, Ridder GJ, Bektas H, Pichlmayr R (1996) Extended resections of ductal pancreatic cancer–impact on operative risk and prognosis. Oncology 53:47–53

    Article  CAS  PubMed  Google Scholar 

  26. Takada T, Yasuda H, Amano H, Yoshida M, Uchida T (1997) Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival? Hepatogastroenterology 44:567–573

    CAS  PubMed  Google Scholar 

  27. Seelig SK, Burkert B, Chromik AM, Tannapfel A, Uhl W, Seelig MH (2010) Pancreatic resections for advanced M1-pancreatic carcinoma: the value of synchronous metastasectomy. HPB Surg 2010:579672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Gleisner AL, Assumpcao L, Cameron JL, Wolfgang CL, Choti MA, Herman JM et al (2007) Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 110:2484–2492

    Article  PubMed  Google Scholar 

  29. Tachezy M, Gebauer F, Janot M, Uhl W, Zerbi A, Montorsi M, Perinel J, Adham M, Dervenis C, Agalianos C, Malleo G, Maggino L, Stein A, Izbicki JR, Bockhorn M (2016) Synchronous resections of hepatic oligometastatic pancreatic cancer: disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery 2:39–60

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  31. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081

    Article  CAS  PubMed  Google Scholar 

  32. Lau MK, Davila JA, Shaib YH (2010) Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States. Pancreas 39:458–462

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany

    Eugen Bellon, Florian Gebauer, Michael Tachezy, Jakob R. Izbicki & Maximilian Bockhorn

Authors
  1. Eugen Bellon
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  2. Florian Gebauer
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  3. Michael Tachezy
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  4. Jakob R. Izbicki
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  5. Maximilian Bockhorn
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Correspondence to Maximilian Bockhorn.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Bellon, E., Gebauer, F., Tachezy, M. et al. Pancreatic cancer and liver metastases: state of the art. Updates Surg 68, 247–251 (2016). https://doi.org/10.1007/s13304-016-0407-7

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  • DOI: https://doi.org/10.1007/s13304-016-0407-7

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