Resection of pancreatic ductal adenocarcinoma with synchronous distant metastasis: is it worthwhile?

World Journal of Surgical Oncology

Denis Pezet¹  David Da Ines²  Johan Gagnière¹  Olivier Antomarchi¹  David Orry³  Emmanuel Buc¹ 

[1] Department of Digestive and HPB Surgery, CHU Estaing - 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France;Department of Radiology, CHU Estaing, Clermont-Ferrand, France;Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France

关键词: Survival;    Chemotherapy;    Surgery;    Metastasis;    Pancreatic cancer;   

Others  :  1147256
DOI  :  10.1186/1477-7819-12-347

 received in 2014-02-23, accepted in 2014-07-04,  发布年份 2014

【 摘 要 】

Background

The purpose of this study is to report prolonged survival in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) managed by chemotherapy and surgery.

Methods

Between January 2009 and August 2013, 284 patients with metastatic PDAC were managed in our oncologic department. Among them, three (1%) with a single metastasis (liver in two cases and interaorticaval in one case) underwent one- or two-stage surgical resection of the metastasis and the main tumor. Perioperative data were recorded retrospectively, including disease-free and overall survival.

Results

The three patients had chemotherapy (FOLFOX or FOLFIRINOX regimen) with objective response or stable disease prior to surgery. Median time between chemotherapy and surgery was 9 (8 to 15) months. Resection consisted in pancreaticoduodenectomy in the three cases. None of the patients had grade III/IV postoperative complications, and median hospital stay was 12 (12 to 22) days. All the patients had postoperative chemotherapy. Only one patient experienced recurrence 11 months after surgery and died after 32.5 months. The two other patients were alive with no recurrence 26.3 and 24.7 months after initial treatment.

Conclusion

Radical resection of PDAC with single distant metastases can offer prolonged survival with low morbidity after accurate selection by neoadjuvant chemotherapy.

【 授权许可】

   
2014 Buc et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010, 127:2893-2917.
• [2]Koninger J, Wente MN, Muller-Stich BP, di Mola FF, Gutt CN, Hinz U, Muller MW, Friess H, Buchler MW: R2 resection in pancreatic cancer–does it make sense? Langenbecks Arch Surg 2008, 393:929-934.
• [3]Le Scodan R, Mornex F, Girard N, Mercier C, Valette PJ, Ychou M, Bibeau F, Roy P, Scoazec JY, Partensky C: Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review. Ann Oncol 2009, 20:1387-1396.
• [4]Bogoevski D, Strate T, Yekebas EF, Izbicki JR: Pancreatic cancer: a generalized disease–prognostic impact of cancer cell dissemination. Langenbecks Arch Surg 2008, 393:911-917.
• [5]Van Laethem JL, Verslype C, Iovanna JL, Michl P, Conroy T, Louvet C, Hammel P, Mitry E, Ducreux M, Maraculla T, Uhl W, Van Tienhoven G, Bachet JB, Maréchal R, Hendlisz A, Bali M, Demetter P, Ulrich F, Aust D, Luttges J, Peeters M, Mauer M, Roth A, Neoptolemos JP, Lutz M, European Society for Medical Oncology: New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel. Ann Oncol 2012, 23:570-576.
• [6]Gleisner AL, Assumpcao L, Cameron JL, Wolfgang CL, Choti MA, Herman JM, Schulick RD, Pawlik TM: Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 2007, 110:2484-2492.
• [7]Shimada K, Kosuge T, Yamamoto J, Yamasaki S, Sakamoto M: Successful outcome after resection of pancreatic cancer with a solitary hepatic metastasis. Hepatogastroenterology 2004, 51:603-605.
• [8]Spinelli GP, Zullo A, Romiti A, Di Seri M, Tomao F, Miele E, Spalletta B, Eramo A, Hassan C, Tomao S: Long-term survival in metastatic pancreatic cancer. A case report and review of the literature. JOP 2006, 7:486-491.
• [9]Ibusuki M, Hiraoka T, Kanemitsu K, Takamori H, Tsuji T: Complete remission of pancreatic cancer after multiple resections of locally pancreatic recurrent sites and liver metastasis: report of a case. Surg Today 2008, 38:563-566.
• [10]Klein F, Puhl G, Guckelberger O, Pelzer U, Pullankavumkal JR, Guel S, Neuhaus P, Bahra M: The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract 2012, 2012:939350.
• [11]Seufferlein T, Bachet JB, Van Cutsem E, Rougier P: Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012, 23(Suppl 7):vii33-vii40.
• [12]Venook AP, Egorin MJ, Rosner GL, Hollis D, Mani S, Hawkins M, Byrd J, Hohl R, Budman D, Meropol NJ, Ratain MJ: Phase I and pharmacokinetic trial of gemcitabine in patients with hepatic or renal dysfunction: Cancer and Leukemia Group B 9565. J Clin Oncol 2000, 18:2780-2787.
• [13]van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ: Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010, 362:129-137.
• [14]Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P, Nelson R, Dorr FA, Stephens CD, Von Hoff DD: 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, 15:2403-2413.
• [15]Berlin JD, Catalano P, Thomas JP, Kugler JW, Haller DG, Benson AB 3rd: Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 2002, 20:3270-3275.
• [16]Kulke MH, Tempero MA, Niedzwiecki D, Hollis DR, Kindler HL, Cusnir M, Enzinger PC, Gorsch SM, Goldberg RM, Mayer RJ: Randomized phase II study of gemcitabine administered at a fixed dose rate or in combination with cisplatin, docetaxel, or irinotecan in patients with metastatic pancreatic cancer: CALGB 89904. J Clin Oncol 2009, 27:5506-5512.
• [17]Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardiere C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011, 364:1817-1825.
• [18]Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, Harris M, Reni M, Dowden S, Laheru D, Bahary N, Ramanathan RK, Tabernero J, Hidalgo M, Goldstein D, Van Cutsem E, Wei X, Iglesias J, Renschler MF: Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013, 369:1691-1703.
• [19]Adham M, Jaeck D, Le Borgne J, Oussoultzouglou E, Chenard-Neu MP, Mosnier JF, Scoazec JY, Mornex F, Partensky C: Long-term survival (5–20 years) after pancreatectomy for pancreatic ductal adenocarcinoma: a series of 30 patients collected from 3 institutions. Pancreas 2008, 37:352-357.
• [20]Bachellier P, Rosso E, Lucescu I, Oussoultzoglou E, Tracey J, Pessaux P, Ferreira N, Jaeck D: Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol 2011, 103:75-84.
• [21]Massucco P, Ribero D, Sgotto E, Mellano A, Muratore A, Capussotti L: Prognostic significance of lymph node metastases in pancreatic head cancer treated with extended lymphadenectomy: not just a matter of numbers. Ann Surg Oncol 2009, 16:3323-3332.
• [22]Michalski CW, Kleeff J, Wente MN, Diener MK, Buchler MW, Friess H: Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 2007, 94:265-273.
• [23]Shrikhande SV, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I, Schmidt J, Friess H, Buchler MW: Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 2007, 14:118-127.
• [24]Yamada S, Nakao A, Fujii T, Sugimoto H, Kanazumi N, Nomoto S, Kodera Y, Takeda S: Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas 2009, 38:e13-e17.
• [25]Strobel O, Hartwig W, Hackert T, Hinz U, Berens V, Grenacher L, Bergmann F, Debus J, Jager D, Buchler M, Werner J: Re-resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with encouraging survival. Ann Surg Oncol 2013, 20:964-972.
• [26]Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH: 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, 236:355-366. discussion 366–358
• [27]Takada Y, Otsuka M, Seino K, Taniguchi H, Koike N, Kawamoto T, Koda K, Adachi S, Yuzawa K, Nozue M, Todoroki T, Fukao K: Hepatic resection for metastatic tumors from noncolorectal carcinoma. Hepatogastroenterology 2001, 48:83-86.
• [28]Michalski CW, Erkan M, Huser N, Muller MW, Hartel M, Friess H, Kleeff J: Resection of primary pancreatic cancer and liver metastasis: a systematic review. Dig Surg 2008, 25:473-480.
• [29]Takada T, Yasuda H, Amano H, Yoshida M, Uchida T: Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival? Hepatogastroenterology 1997, 44:567-573.
• [30]Tani M, Kawai M, Miyazawa M, Hirono S, Ina S, Nishioka R, Fujita Y, Uchiyama K, Yamaue H: Liver metastasis as an initial recurrence has no impact on the survival of patients with resectable pancreatic adenocarcinoma. Langenbecks Arch Surg 2009, 394:249-253.
• [31]Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999, 230:309-318. discussion 318–321
• [32]Nagai S, Fujii T, Kodera Y, Kanda M, Sahin TT, Kanzaki A, Hayashi M, Sugimoto H, Nomoto S, Takeda S, Morita S, Nakao A: Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol 2011, 18:2329-2337.
• [33]Laurent C, Rullier E, Feyler A, Masson B, Saric J: Resection of noncolorectal and nonneuroendocrine liver metastases: late metastases are the only chance of cure. World J Surg 2001, 25:1532-1536.
• [34]Malik HZ, Farid S, Al-Mukthar A, Anthoney A, Toogood GJ, Lodge JP, Prasad KR: A critical appraisal of the role of neoadjuvant chemotherapy for colorectal liver metastases: a case-controlled study. Ann Surg Oncol 2007, 14:3519-3526.
• [35]Heinemann V, Quietzsch D, Gieseler F, Gonnermann M, Schonekas H, Rost A, Neuhaus H, Haag C, Clemens M, Heinrich B, Vehling-Kaiser U, Fuchs M, Fleckenstein D, Gesierich W, Uthgenannt D, Einsele H, Holstege A, Hinke A, Schalhorn A, Wilkowski R: Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 2006, 24:3946-3952.
• [36]Boone BA, Steve J, Krasinskas AM, Zureikat AH, Lembersky BC, Gibson MK, Stoller RG, Zeh HJ, Bahary N: Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol 2013, 108:236-241.
• [37]Hosein PJ, Macintyre J, Kawamura C, Maldonado JC, Ernani V, Loaiza-Bonilla A, Narayanan G, Ribeiro A, Portelance L, Merchan JR, Levi JU, Rocha-Lima CM: A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer 2012, 12:199. BioMed Central Full Text
• [38]Abbott DE, Tzeng CW, Merkow RP, Cantor SB, Chang GJ, Katz MH, Bentrem DJ, Bilimoria KY, Crane CH, Varadhachary GR, Abbruzzese JL, Wolff RA, Lee JE, Evans DB, Fleming JB: The Cost-Effectiveness of Neoadjuvant Chemoradiation is Superior to a Surgery-First Approach in the Treatment of Pancreatic Head Adenocarcinoma. Ann Surg Oncol 2013, 20(Suppl 3):S500-S508.