DOI QR코드

DOI QR Code

Impact of Surgery on Oligometastatic Pancreatic Cancer: Current Status and Future Perspectives

  • Received : 2022.10.31
  • Accepted : 2022.11.23
  • Published : 2023.04.20

Abstract

Pancreatic cancer treatment has advanced. In particular, effective chemotherapy regimen development has fundamentally altered the therapeutic concept and strategy for pancreatic cancer treatment. Consequently, the prognosis of patients with pancreatic cancer has gradually improved. Conversion surgery for locally advanced pancreatic cancer may offer long-term survival or even a full recovery in some individuals. In contrast, metastatic pancreatic cancer has long been considered a surgical contraindication because aggressive surgical resection of the metastatic lesions does not prolong patient survival. Unexpectedly positive benefits of anticancer therapy in recent clinical experience were observed even with metastatic pancreatic cancer. To date, little evidence presented the success of surgical resection for metastatic pancreatic cancer treatment in such rare cases. However, hope and concern are growing that surgical intervention, even in patients with metastatic cancer, may result in favorable outcomes. Several studies suggested different surgical intervention effects depending on metastasis sites and patterns. Thus, this review summarizes the current status of surgery in the multidisciplinary treatment of oligometastatic pancreatic cancer and discusses future perspectives.

Keywords

References

  1. Ishido K, Hakamada K, Kimura N, Miura T, Wakiya T. Essential updates 2018/2019: current topics in the surgical treatment of pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg 2020;5:7-23. https://doi.org/10.1002/ags3.12379 
  2. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995;13:8-10. https://doi.org/10.1200/JCO.1995.13.1.8 
  3. Tachezy M, Gebauer F, Janot M, et al. Synchronous resections of hepatic oligometastatic pancreatic cancer: disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery 2016;160:136-144. https://doi.org/10.1016/j.surg.2016.02.019 
  4. Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 2017;43:358-363. https://doi.org/10.1016/j.ejso.2016.10.023 
  5. Safi SA, Fluegen G, Rehders A, et al. Surgical margin clearance and extended chemotherapy defines survival for synchronous oligometastatic liver lesions of the ductal adenocarcinoma of the pancreas. Int J Clin Oncol 2021;26:1911-1921. https://doi.org/10.1007/s10147-021-01961-5 
  6. Takeda T, Sasaki T, Okamoto T, et al. Outcomes of pancreatic cancer with liver oligometastasis. J Hepatobiliary Pancreat Sci 2022. doi: 10.1002/jhbp.1184. [Epub ahead of print] 
  7. 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. 
  8. Gleisner AL, Assumpcao L, Cameron JL, et al. Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 2007;110:2484-2492. https://doi.org/10.1002/cncr.23074 
  9. Seelig SK, Burkert B, Chromik AM, Tannapfel A, Uhl W, Seelig MH. Pancreatic resections for advanced M1-pancreatic carcinoma: the value of synchronous metastasectomy. HPB Surg 2010;2010:579672. https://doi.org/10.1155/2010/579672 
  10. Dunschede F, Will L, von Langsdorf C, et al. Treatment of metachronous and simultaneous liver metastases of pancreatic cancer. Eur Surg Res 2010;44:209-213. https://doi.org/10.1159/000313532 
  11. Zanini N, Lombardi R, Masetti M, Giordano M, Landolfo G, Jovine E. Surgery for isolated liver metastases from pancreatic cancer. Updates Surg 2015;67:19-25. https://doi.org/10.1007/s13304-015-0283-6 
  12. Wright GP, Poruk KE, Zenati MS, et al. Primary tumor resection following favorable response to systemic chemotherapy in stage IV pancreatic adenocarcinoma with synchronous metastases: a bi-institutional analysis. J Gastrointest Surg 2016;20:1830-1835. https://doi.org/10.1007/s11605-016-3256-2 
  13. Crippa S, Bittoni A, Sebastiani E, et al. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol 2016;42:1533-1539. https://doi.org/10.1016/j.ejso.2016.06.398 
  14. Frigerio I, Regi P, Giardino A, et al. Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol 2017;24:2397-2403. https://doi.org/10.1245/s10434-017-5885-4 
  15. Tanaka M, Heckler M, Mihaljevic AL, et al. CT response of primary tumor and CA19-9 predict resectability of metastasized pancreatic cancer after FOLFIRINOX. Eur J Surg Oncol 2019;45:1453-1459. https://doi.org/10.1016/j.ejso.2019.03.039 
  16. Shao Y, Feng J, Hu Z, et al. Feasibility of pancreaticoduodenectomy with synchronous liver metastasectomy for oligometastatic pancreatic ductal adenocarcinoma - a case-control study. Ann Med Surg (Lond) 2020;62:490-494. https://doi.org/10.1016/j.amsu.2020.11.037 
  17. Hank T, Klaiber U, Hinz U, et al. Oncological outcome of conversion surgery after preoperative chemotherapy for metastatic pancreatic cancer. Ann Surg 2022. doi: 10.1097/SLA.0000000000005481. [Epub ahead of print] 
  18. Bachellier P, Addeo P, Averous G, Dufour P. Resection of pancreatic adenocarcinomas with synchronous liver metastases: a retrospective study of prognostic factors for survival. Surgery 2022;172:1245-1250. https://doi.org/10.1016/j.surg.2022.03.003 
  19. Hamad A, Underhill J, Ansari A, et al. Surgical treatment of hepatic oligometastatic pancreatic ductal adenocarcinoma: an analysis of the National Cancer Database. Surgery 2022;171:1464-1470. https://doi.org/10.1016/j.surg.2021.12.029 
  20. Shrikhande SV, Kleeff J, Reiser C, et al. Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 2007;14:118-127. https://doi.org/10.1245/s10434-006-9131-8 
  21. Yamada S, Fujii T, Sugimoto H, et al. Pancreatic cancer with distant metastases: a contraindication for radical surgery? Hepatogastroenterology 2009;56:881-885. 
  22. Satoi S, Fujii T, Yanagimoto H, et al. Multicenter phase II study of intravenous and intraperitoneal paclitaxel with S-1 for pancreatic ductal adenocarcinoma patients with peritoneal metastasis. Ann Surg 2017;265:397-401. https://doi.org/10.1097/SLA.0000000000001705 
  23. Yamada S, Fujii T, Yamamoto T, et al. Conversion surgery in patients with pancreatic cancer and peritoneal metastasis. J Gastrointest Oncol 2021;12(Suppl 1):S110-S117. https://doi.org/10.21037/jgo-20-243 
  24. Yamamoto T, Satoi S, Yamaki S, et al. Intraperitoneal paclitaxel treatment for patients with pancreatic ductal adenocarcinoma with peritoneal dissemination provides a survival benefit. Cancers (Basel) 2022;14:1354. https://doi.org/10.3390/cancers14051354 
  25. Arnaoutakis GJ, Rangachari D, Laheru DA, et al. Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival. J Gastrointest Surg 2011;15:1611-1617. https://doi.org/10.1007/s11605-011-1605-8 
  26. Thomas RM, Truty MJ, Nogueras-Gonzalez GM, et al. Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg 2012;16:1696-1704. https://doi.org/10.1007/s11605-012-1912-8 
  27. Downs-Canner S, Zenati M, Boone BA, et al. The indolent nature of pulmonary metastases from ductal adenocarcinoma of the pancreas. J Surg Oncol 2015;112:80-85. https://doi.org/10.1002/jso.23943 
  28. Robinson LA, Tanvetyanon T, Springett G, et al. Pulmonary metastasectomy for suspected pancreaticobiliary cancer. J Thorac Cardiovasc Surg 2016;152:75-82. https://doi.org/10.1016/j.jtcvs.2016.02.066 
  29. Yasukawa M, Kawaguchi T, Kawai N, Tojo T, Taniguchi S. Surgical treatment for pulmonary metastasis of pancreatic ductal adenocarcinoma: study of 12 cases. Anticancer Res 2017;37:5573-5576. https://doi.org/10.21873/anticanres.11990 
  30. Okui M, Yamamichi T, Asakawa A, Harada M, Horio H. Resection for pancreatic cancer lung metastases. Korean J Thorac Cardiovasc Surg 2017;50:326-328. https://doi.org/10.5090/kjtcs.2017.50.5.326 
  31. Mashiko T, Nakano A, Masuoka Y, Yamamoto S, Ozawa S, Nakagohri T. Significance of pulmonary resection in patients with metachronous pulmonary metastasis from pancreatic ductal adenocarcinoma: a retrospective cohort study. BMC Surg 2021;21:237. https://doi.org/10.1186/s12893-021-01236-w 
  32. Homma Y, Endo I, Matsuyama R, et al. Outcomes of lung metastasis from pancreatic cancer: a nationwide multicenter analysis. J Hepatobiliary Pancreat Sci 2022;29:552-561. https://doi.org/10.1002/jhbp.1127 
  33. Yun WG, Kwon W, Han Y, et al. Can surgical resection of metastatic lesions be beneficial to pancreatic ductal adenocarcinoma patients with isolated lung metastasis? Cancers (Basel) 2022;14:2067. https://doi.org/10.3390/cancers14092067 
  34. Sakaguchi T, Valente R, Tanaka K, Satoi S, Del Chiaro M. Surgical treatment of metastatic pancreatic ductal adenocarcinoma: a review of current literature. Pancreatology 2019;19:672-680. https://doi.org/10.1016/j.pan.2019.05.466 
  35. Sasaki T, Nishiwada S, Nakagawa K, et al. Integrative analysis identifies activated anti-tumor immune microenvironment in lung metastasis of pancreatic cancer. Int J Clin Oncol 2022;27:948-957. https://doi.org/10.1007/s10147-022-02131-x 
  36. Wei M, Shi S, Hua J, Xu J, Yu X. Simultaneous resection of the primary tumour and liver metastases after conversion chemotherapy versus standard therapy in pancreatic cancer with liver oligometastasis: protocol of a multicentre, prospective, randomised phase III control trial (CSPAC-1). BMJ Open 2019;9:e033452. https://doi.org/10.1136/bmjopen-2019-033452 
  37. Gebauer F, Damanakis AI, Popp F, et al. Study protocol of an open-label, single arm phase II trial investigating the efficacy, safety and quality of life of neoadjuvant chemotherapy with liposomal irinotecan combined with oxaliplatin and 5-fluorouracil/Folinic acid followed by curative surgical resection in patients with hepatic oligometastatic adenocarcinoma of the pancreas (HOLIPANC). BMC Cancer 2021;21:1239. https://doi.org/10.1186/s12885-021-08966-3 
  38. Yamamoto T, Fujii T, Hirano S, et al. Randomized phase III trial of intravenous and intraperitoneal paclitaxel with S-1 versus gemcitabine plus nab-paclitaxel for pancreatic ductal adenocarcinoma with peritoneal metastasis (SP study). Trials 2022;23:119. https://doi.org/10.1186/s13063-022-06049-7