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A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy

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Abstract

Recent studies considered surgery as a treatment option for patients with pancreatic ductal adenocarcinoma (PDAC) and synchronous liver metastases. The aim of this study was to evaluate systematically the literature on the role of surgical resection in this setting as an upfront procedure or following primary chemotherapy. A systematic search was performed of PubMed, Embase and the Cochrane Library in accordance with PRISMA guidelines. Only studies that included patients with synchronous liver metastases published in the era of multiagent chemotherapy (after 2011) were considered, excluding those with lung/peritoneal metastases or metachronous liver metastases. Median overall survival (OS) was the primary outcome. Six studies with 204 patients were analyzed. 63% of patients underwent upfront pancreatic and liver resection, 35% had surgery after primary chemotherapy with strict selection criteria and 2% had an inverse approach (liver surgery first). 38 patients (18.5%) did not undergo any liver resection since metastases disappeared after chemotherapy. Postoperative mortality was low (< 2%). Median OS ranged from 7.6 to 14.5 months after upfront pancreatic/liver resection and from 34 to 56 months in those undergoing preoperative treatment. This systematic review suggests that surgical resection of pancreatic cancer with synchronous liver oligometastases is safe, and it can be associated with improved survival, providing a careful selection of patients after primary chemotherapy.

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References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics. CA Cancer J Clin 66:7–30

    Article  Google Scholar 

  2. Kamisawa T, Wood LD, Itoi T, Takaori K (2016) Pancreatic cancer. Lancet 388:73–85

    Article  CAS  Google Scholar 

  3. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:1028–1061

    Article  Google Scholar 

  4. 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 160:136–144

    Article  Google Scholar 

  5. Crippa S, Bittoni A, Sebastiani E et al (2016) Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol 42:1533–1539

    Article  CAS  Google Scholar 

  6. Hackert T, Hinz U, Pausch T et al (2016) Postoperative pancreatic fistula: we need to redefine grades B and C. Surgery 159:872–877

    Article  Google Scholar 

  7. Pulvirenti A, Marchegiani G, Pea A et al (2017) Clinical implications of the 2016 International Study Group on Pancreatic Surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections. Ann Surg. https://doi.org/10.1097/sla.0000000000002362

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  9. 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  Google Scholar 

  10. Reni M, Zanon S, Balzano G et al (2017) Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol 28:2786–2792

    Article  CAS  Google Scholar 

  11. Frigerio I, Regi P, Giardino A et al (2017) Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol 24:2397–2403

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  13. http://www.crd.york.ac.uk/prospero

  14. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  Google Scholar 

  15. National Institute for Health and Clinical Excellence. NICE clinical guidelines, Appendix 4 Quality of case series form. http://www.nice.org.uk/nicemedia/pdf/Appendix_04_qualityofcase_series_form_preop.pdf

  16. Wright GP, Poruk KE, Zenati MS et al (2016) Primary tumor resection following favorable response to systemic chemotherapy in stage IV pancreatic adenocarcinoma with synchronous metastases: a bi-institutional analysis. J Gastrointest Surg 20:1830–1835

    Article  Google Scholar 

  17. Klein F, Puhl G, Guckelberger O et al (2012) The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract 2012:939350

    Article  CAS  Google Scholar 

  18. Reni M, Cereda S, Rognone A et al (2012) A randomized phase II trial of two different 4-drug combinations in advanced pancreatic adenocarcinoma: cisplatin, capecitabine, gemcitabine plus either epirubicin or docetaxel (PEXG or PDXG regimen). Cancer Chemother Pharmacol 69:115–123

    Article  CAS  Google Scholar 

  19. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  Google Scholar 

  20. Downs-Canner S, Zenati M, Boone BA et al (2015) The indolent nature of pulmonary metastases from ductal adenocarcinoma of the pancreas. J Surg Oncol 112:80–85

    Article  Google Scholar 

  21. Wangjam T, Zhang Z, Zhou XC et al (2015) Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns. Oncotarget 6:36903–36910

    Article  Google Scholar 

  22. Agalianos C, Gouvas N, Papaparaskeva K, Dervenis C (2016) Positive para-aortic lymph nodes following pancreatectomy for pancreatic cancer. Systematic review and meta-analysis of impact on short term survival and association with clinicopathologic features. HPB (Oxford) 18:633–641

    Article  Google Scholar 

  23. Tabernero J, Kunzmann V, Scheithauer W et al (2017) nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: a subgroup analysis of the Western European cohort of the MPACT trial. Onco Targets Ther 10:591–596

    Article  CAS  Google Scholar 

  24. de Jesus VHF, Camandaroba MPG, Donadio MDS et al (2018) Retrospective comparison of the efficacy and the toxicity of standard and modified FOLFIRINOX regimens in patients with metastatic pancreatic adenocarcinoma. J Gastrointest Oncol 9:694–707

    Article  Google Scholar 

  25. de Geus SW, Evans DB, Bliss LA et al (2016) Neoadjuvant therapy versus upfront surgical strategies in resectable pancreatic cancer: a Markov decision analysis. Eur J Surg Oncol 42:1552–1560

    Article  Google Scholar 

  26. Christians KK, Heimler JW, George B et al (2016) Survival of patients with resectable pancreatic cancer who received neoadjuvant therapy. Surgery 159:893–900

    Article  Google Scholar 

  27. Sohal DPS, Willingham FF, Falconi M, Raphael KL, Crippa S (2017) Pancreatic adenocarcinoma: improving prevention and survivorship. Am Soc Clin Oncol Educ Book 37:301–310

    Article  Google Scholar 

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Acknowledgements

Dr. Reni reports grants, personal fees and non-financial support from Celgene, grants and personal fees from Baxalta, grants and personal fees from Merck Serono, grants from Helsinn, personal fees from Lilly, personal fees from Pfizer, personal fees from Astra Zeneca, personal fees from Novocure, personal fees from Halozyme, personal fees from Novartis, personal fees from Shire.

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Authors and Affiliations

  1. Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy

    Stefano Crippa, Stefano Partelli, Michele Reni & Massimo Falconi

  2. Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

    Roberto Cirocchi

  3. Department of Surgery, Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Matthew J. Weiss & Christopher L. Wolfgang

  4. Department of Surgery, University of Heidelberg, Heidelberg, Germany

    Thilo Hackert

  5. Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Stefano Crippa & Massimo Falconi

Authors
  1. Stefano Crippa
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  2. Roberto Cirocchi
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  3. Matthew J. Weiss
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  4. Stefano Partelli
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  5. Michele Reni
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  6. Christopher L. Wolfgang
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  7. Thilo Hackert
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  8. Massimo Falconi
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Contributions

The authors meet the following criteria for authorship: substantial contributions to the conception or design of the work (SC, RC, CLW, TH, MF); or the acquisition, analysis, or interpretation of data for the work (all authors); drafting the work (SC, RC) or revising it critically for important intellectual content (all authors); final approval of the version to be published (all authors); agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (all authors).

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Correspondence to Massimo Falconi.

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

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For this type of study, no informed consent was needed. The authors did not perform any procedures on patients in this manuscript (overview).

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Crippa, S., Cirocchi, R., Weiss, M.J. et al. A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy. Updates Surg 72, 39–45 (2020). https://doi.org/10.1007/s13304-020-00710-z

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  • DOI: https://doi.org/10.1007/s13304-020-00710-z

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