title: Pancreatic resections for advanced M1-pancreatic carcinoma: the value of synchronous metastasectomy.
abstract: BACKGROUND
  For M1 pancreatic adenocarcinomas pancreatic resection is usually not indicated. However, in highly selected patients synchronous metastasectomy may be appropriate together with pancreatic resection when operative morbidity is low.
  
  
  METHODS
  From January 1, 2004 to December, 2007 a total of 20 patients with pancreatic malignancies were retrospectively evaluated who underwent pancreatic surgery with synchronous resection of hepatic, adjacent organ, or peritoneal metastases for proven UICC stage IV periampullary cancer of the pancreas. Perioperative as well as clinicopathological parameters were evaluated.
  
  
  RESULTS
  There were 20 patients (9 men, 11 women; mean age 58 years) identified. The primary tumor was located in the pancreatic head (n = 9, 45%), in pancreatic tail (n = 9, 45%), and in the papilla Vateri (n = 2, 10%). Metastases were located in the liver (n = 14, 70%), peritoneum (n = 5, 25%), and omentum majus (n = 2, 10%). Lymphnode metastases were present in 16 patients (80%). All patients received resection of their tumors together with metastasectomy. Pylorus preserving duodenopancreatectomy was performed in 8 patients, distal pancreatectomy in 8, duodenopancreatectomy in 2, and total pancreatectomy in 2. Morbidity was 45% and there was no perioperative mortality. Median postoperative survival was 10.7 months (2.6-37.7 months) which was not significantly different from a matched-pair group of patients who underwent pancreatic resection for UICC adenocarcinoma of the pancreas (median survival 15.6 months; P = .1).
  
  
  CONCLUSIONS
  Pancreatic resection for M1 periampullary cancer of the pancreas can be performed safely in well-selected patients. However, indication for surgery has to be made on an individual basis.
authors.affiliation: Department of Gynecology, North-West-Hospital Frankfurt, Academic Teaching Hospital, University of Frankfurt, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany.
authors.forename: S K
authors.initials: SK
authors.lastname: Seelig
authors.forename: B
authors.initials: B
authors.lastname: Burkert
authors.forename: A M
authors.initials: AM
authors.lastname: Chromik
authors.forename: A
authors.initials: A
authors.lastname: Tannapfel
authors.forename: W
authors.initials: W
authors.lastname: Uhl
authors.forename: M H
authors.initials: MH
authors.lastname: Seelig
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome