Primary Tumor Resection Following Favorable Response to Systemic Chemotherapy in Stage IV Pancreatic Adenocarcinoma with Synchronous Metastases: a Bi-institutional Analysis.
Patients with metastatic pancreatic adenocarcinoma have traditionally been offered palliative chemotherapy alone, and the role of surgery in these patients remains unknown.



A bi-institutional retrospective review was performed for patients with metastatic pancreatic adenocarcinoma who underwent resection of the primary tumor from 2008 to 2013. The primary outcome measured was postoperative overall survival. Secondary outcomes included postoperative disease-free survival and overall survival from the time of diagnosis.



Twenty-three patients were identified who met the study criteria with a median follow-up of 30 months. Metastatic sites included the liver (n = 16), the lung (n = 6), and the peritoneum (n = 2). Chemotherapy included FOLFIRINOX (n = 14) and gemcitabine-based regimens (n = 9), with a median of 9 cycles (range 2-31) prior to surgical treatment. Median time from diagnosis to surgery was 9.7 months (IQR 5.8-12.8). Median overall survival (OS) from surgery, disease-free survival, and OS from diagnosis were 18.2 months (95 % CI 11.8-35.5), 8.6 months (95 % CI 5.2-16.8), and 34.1 months (95 % CI 22.5-46.2), respectively. The 1- and 3-year OS from surgery were 72.7 % (95 % CI 49.1-86.7) and 21.5 % (95 % CI 4.3-47.2), respectively.



Resection of the primary tumor in patients with metastatic pancreatic adenocarcinoma may be considered in highly selected patients with favorable imaging and CA 19-9 response following chemotherapy at high-volume centers providing multidisciplinary care. These patients should be enrolled in prospective clinical trials or institutional registries to better quantify the potential benefits of such a strategy.
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA. wrightgp@upmc.edu.
G Paul
0000-0001-9299-0408
GP
Wright
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Katherine E
KE
Poruk
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA.
Mazen S
MS
Zenati
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA.
Jennifer
J
Steve
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Nathan
N
Bahary
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA.
Melissa E
ME
Hogg
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA.
Amer H
AH
Zuriekat
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Christopher L
CL
Wolfgang
Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA, 15232, USA.
Herbert J
HJ
Zeh
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Matthew J
MJ
Weiss
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D000093542:Gemcitabine
D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine
Metastasectomy; Metastatic; Pancreatic cancer