Philipp R Scherber, Jochen Schuld, Monika Schlüter, Maximilian von Heesen, Jurgita Mikneviciute, Sebastian Holländer, Peter Jacob, Gereon Gäbelein, Robert Eisele, Dorian Igna, Matthias Glanemann
Introduction Only around 20% of patients are diagnosed with a primarily resectable pancreatic ductal adenocarcinoma. However, some of these patients show intraoperatively the incidental finding of a solitary, resectable liver metastasis (LM). Another 15- 20% of tumors are locally- advanced or involving surrounding organs at diagnosis. The objective of this study was to investigate first if the long- term survival of these patients can be improved by an extended resection (ER) and second to point out the strongest predictors for long- term survival. Patients and methods All patients with locally- advanced tumors or those with intraoperatively diagnosed, unexpected, solitary LM between January 2002 and December 2013 were analyzed retrospectively. The ER was defined as the simultaneous resection of adjacent organs or solitary LM. For statistical analyses, these patients´ long- term survival was compared with the one of patients who did not undergo oncological tumor resection in case of locally- advanced cancer. Results 40 patients (17 men, 23 women, age 68 ± 9.5 years) underwent ER and another 40 patient’s only explorative laparotomy or palliative surgical treatment. After ER, patients had a significantly better longterm survival (10.8 ± 2.85 vs. 6.43 ± 2.43 months, p=0.02). The R0- resection and the application of a postoperative chemotherapy were the strongest predictors for long- term survival. Conclusion In case of locally- advanced ductal pancreatic adenocarcinoma or intraoperatively diagnosed, unexpected, solitary LM, selected patients can benefit from an extended resection in order to achieve clearness of tumor. The R0- resection and the use of postoperative chemotherapy are the strongest predictors for long- term survival.
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