Liver resection for synchronous metastasis from adenocarcinoma of the pancreas: international multicenter cohort study

Introduction: Treatment aiming to cure pancreatic ductal adenocarcinoma (PDAC) is primarily based on radical surgical resection. However, in most patients, distant metastases are already detectable at the time of diagnosis, preventing a curative treatment pathway. Methods: Cases of PDAC with synchronous liver metastasis were collected from 14 international centers across multiple countries and continents. The study was promoted by the International Society of Liver Surgeons (ISLS) to define the role of simultaneous pancreatic and liver surgery in the treatment of oligometastatic PDAC. Overall survival (OS) and the cumulative incidence function of recurrence were estimated in a surgical cohort, and OS was compared with that of a non-surgical control group. Results: Fifty patients were included in the surgical cohort. Most of the procedures were Whipples (60%), associated with wedge resections of the liver (86%). The median hospital stay was 10 days, with a median Comprehensive Complication Index (CCI) of 12, and 68% of the patients spent no more than 1 day in the intensive care unit (ICU). In the surgical group, OS at 6, 12, and 24 months after surgery was 83%, 69%, and 49%, respectively. The adjusted hazard ratio (HR) (surgical vs non-surgical cohort) was 0.26 (95% CI: 0.12–0.55, P < 0.001). Conclusions: The results of this international multicenter study further support the hypothesis that oligometastatic PDAC represents an intermediate stage between localized and overtly metastatic cancer. Therefore, following primary chemotherapy and in carefully selected patients based on the A–B–C paradigm, resection of the primary pancreatic tumor along with liver metastases may be considered.