Shinichi Ikuta, Takashi Sonoda, Tsukasa Aihara, Tomojiro Ono, Takayoshi Nakajima, Naoki Yamanaka
Context Little information is available regarding the role of surgical resection for metastatic pancreatic carcinoma, especially that with multiple liver metastases. Objective The aim of the study was to evaluate the results of adjuvant surgery for pancreatic carcinoma patients with multiple liver metastases that responded well to combination chemotherapy. Methods We retrospectively identified 8 patients undergoing adjuvant surgery for pancreatic carcinoma with multiple liver metastases between February 2011 and May 2014. Preoperatively, a cytotoxic regimen consisting of gemcitabine, S-1, docetaxel, and carboplatin in combination with itraconazole oral solution was administered to all the patients. Hepatic arterial infusion chemotherapy with gemcitabine and carboplatin also was used in 7 patients. All 8 patients met the following criteria: with no evidence of locally unresectable disease, absence of extrahepatic metastases, and wellcontrolled disease at the time of adjuvant surgery. Results The median interval between initiation of chemotherapy and adjuvant surgery was 11 (range 6-50) months. Responses to preoperative treatment were 6 partial responses and 1 stable disease for primary lesions, and 1 complete response and 7 partial response for liver metastatic lesions, respectively. Six patients underwent pancreatic resection with synchronous liver resection, while 1 who achieved complete response of liver lesions underwent pancreatic resection alone, and the remaining 1 underwent liver resection alone for metachronous disease. Concomitant ablative therapy to treat deep located liver lesions was applied in 6 patients. Although 2 (25%) patients developed major (Clavien-Dindo grade III) postoperative complications, no patients died perioperatively. Histopathologically, more than 50% destruction of tumor cells was observed in all resected specimens. With a median follow-up of 29 months (range, 20-66 months), all the patients survived 1 year or more after adjuvant surgery (median (range), 17 (12-38) months). An estimated overall survival at 2- and 3-years from initiation of chemotherapy reached 86% and 54%, respectively. Conclusion The results indicate that pancreatic carcinoma with multiple liver metastases should not be uniformly considered a contraindication to surgery providing that durable disease control is obtained by chemotherapy.
