title: Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival.
abstract: OBJECTIVE
  This study was conducted to determine if pulmonary metastasectomy (PM) for isolated pancreatic cancer metastases is safe and effective.
  
  
  METHODS
  This was a retrospective case-control study of patients undergoing PM at our institution from 2000 to 2009 for isolated lung metastasis after resection for pancreatic cancer. Clinical and pathologic data were compared with a matched reference group. Resected neoplasms were immunolabeled for the Dpc4 protein. Kaplan-Meier analysis compared overall survival and survival after relapse.
  
  
  RESULTS
  Of 31 patients with isolated lung metastasis, 9 underwent 10 pulmonary resections. At initial pancreas resection, all patients were stage I or II. Other baseline characteristics were similar between the two groups. Median time from pancreatectomy to PM was 34 months (interquartile range 21-49). During the study, 29/31(90.6%) patients died. There were no in-hospital mortalities or complications after PM. Median cumulative survival was significantly improved in the PM group (51 vs. 23 months, p = 0.04). There was a trend toward greater 2-year survival after relapse in the PM group (40% vs. 27%, p = 0.2).
  
  
  CONCLUSIONS
  In patients with isolated lung metastasis from pancreatic adenocarcinoma, this is the first study to show that pulmonary resection can be performed safely with low morbidity and mortality. The improved survival in the PM group may result in part from selection bias but may also represent a benefit of the procedure.
authors: Division of Thoracic Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: George J
authors: GJ
authors: Arnaoutakis
authors: Deepa
authors: D
authors: Rangachari
authors: Daniel A
authors: DA
authors: Laheru
authors: Chris A
authors: CA
authors: Iacobuzio-Donahue
authors: Ralph H
authors: RH
authors: Hruban
authors: Joseph M
authors: JM
authors: Herman
authors: Barish H
authors: BH
authors: Edil
authors: Timothy M
authors: TM
authors: Pawlik
authors: Richard D
authors: RD
authors: Schulick
authors: John L
authors: JL
authors: Cameron
authors: Avedis
authors: A
authors: Meneshian
authors: Stephen C
authors: SC
authors: Yang
authors: Christopher L
authors: CL
authors: Wolfgang
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000556:secondary / Q000601:surgery*; D000368:Aged; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000737:chemistry / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D051901:Smad4 Protein / Q000032:analysis; D016896:Treatment Outcome
chemical_list: C497796:SMAD4 protein, human; D051901:Smad4 Protein