title: Pancreatic Metastasectomy-an Analysis of Survival Outcomes and Prognostic Factors.
abstract: The pancreas and peripancreatic region may be a site of metastasis from distant sites. Recent data suggest that pancreatic metastasectomy may achieve long-term survival. We seek to examine our experience with this metastasectomy by reporting the perioperative and survival outcomes.
  
  
  
  Patients undergoing resection of isolated pancreatic metastasis were identified from a prospective pancreatic surgical database at the Department of Gastrointestinal Surgery, North Shore campus of the University of Sydney between January 2004 and June 2015 and selected for retrospective review. Data on operative morbidity and mortality were reported. Survival analysis was performed using the Kaplan-Meier method.
  
  
  
  Fifteen patients underwent pancreatic metastasectomy after a median disease-free interval of 63 months (range 0 to 199). Pancreatoduodenectomy was performed in six patients (40 %), distal pancreatectomy with or without splenectomy in three patients (20 %), and pancreatectomy with other visceral organ resection in six patients (40 %). Major complications occurred in six patients (40 %) without mortality. The median survival was 40 months (95 % CI 24.3 to 53.7), and 1-, 3-, and 5-year survival were 76, 48, and 31 % respectively. Cox proportional hazard model identified margin negative resection (hazard ratio (HR) 10.5; P = 0.044) as a predictor of improved survival.
  
  
  
  Long-term survival may be achieved in selected patients with pancreatic metastasis through pancreatic metastasectomy with acceptable morbidity. Selection of patients should be individualized and based on their primary disease origin, biological behavior of the tumor, resectability of the tumor, and the relative effectiveness of systemic or targeted therapies.
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia. terence.c.chua@gmail.com.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia. terence.c.chua@gmail.com.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors.forename: Wilson
authors.initials: W
authors.lastname: Petrushnko
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia.|University of Sydney, Sydney, NSW, Australia.|Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.|Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059146:Metastasectomy / Q000401:mortality; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Chemotherapy; Metastasectomy; Metastasis; Pancreas; Pancreatoduodenectomy