title: Survival Impact of Pulmonary Metastasis as Recurrence of Pancreatic Ductal Adenocarcinoma.
abstract: OBJECTIVE
  This study aimed at investigating the survival impact of pancreatic ductal adenocarcinoma (PDAC) recurrence as pulmonary metastasis.
  
  
  METHODS
  We performed a retrospective case-control study of 142 patients who underwent curative resection for PDAC at our institution between 2003 and 2012. Clinicopathological features were compared among patients stratified according to the recurrence pattern and pulmonary metastasis treatment strategy.
  
  
  RESULTS
  Patients underwent pancreaticoduodenectomy (n = 96), distal (n = 42), or total pancreatectomy (n = 4). At the last follow-up, 99 patients had developed recurrent post-resection PDAC, including 14 cases of isolated pulmonary recurrence. The median overall survival was significantly longer for patients with isolated pulmonary recurrence (40.3 months) than with other metastases (20.9 months; HR 5.85; p = 0.0156). Two patients underwent resection for isolated pulmonary recurrence, and both survived for ∼70 months after primary resection.
  
  
  CONCLUSIONS
  Patients with first recurrence of PDAC as pulmonary metastasis had a better prognosis than patients with other types of metastases. Moreover, when isolated pulmonary metastasis is controlled for a certain period, pulmonary resection is likely to improve patient survival.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yamashita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Hama
authors.forename: Tadafumi
authors.initials: T
authors.lastname: Asaoka
authors.forename: Sakae
authors.initials: S
authors.lastname: Maeda
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Omiya
authors.forename: Koji
authors.initials: K
authors.lastname: Takami
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000556:secondary*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D015996:Survival Rate