Synchronous resection of hepatopancreatic lesions in treatment of hepatic oligometastatic pancreatic cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Ming ^1,2 , WAN Wenwu ¹ , JIANG Ou ³ , YAO Huihua ⁴ ,  DING Bing ¹

1. Department of Hepatobiliary Surgery, Neijiang Second People’s Hospital, Neijiang, Sichuan 641000, P. R. China;
2. Neijiang Health Vocational College, Neijiang, Sichuan 641000, P. R. China;
3. Tumor Center, Neijiang Second People’s Hospital, Neijiang, Sichuan 641000, P. R. China;
4. Department of Hepatobiliary Surgery, Chengdu First People’s Hospital, Chengdu 610095, P. R. China;

Corresponding author：

DING Bing, Email: scdingbing@sina.com

Keywords：

pancreatic cancer; oligohepatic metastasis; surgery; prognosis; influence factor

DOI：

10.7507/1007-9424.202203071

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the curative effect of synchronous resection of hepatopancreas lesions in the treatment of hepatic oligometastatic pancreatic cancer. Methods The patients with hepatic oligometastatic pancreatic cancer who met the inclusion and exclusion criteria in the Neijiang Second People’s Hospital from January 2016 to December 2020 were retrospectively collected. The enrolled patients were divided into resection group and non-resection group according to the treatment method. The patients in the resection group were treated with synchronous resection of hepatopancreas lesions, the patients in the non-resection group were treated with conservative treatment including palliative bypass surgery, biliary drainage, systemic chemotherapy, and so on. The patients were followed up to December 2021. The overall survival of the patients in the two groups were compared, and the factors affecting the overall survival were analyzed. Results A total of 54 patients who met the inclusion and exclusion criteria were collected in this study, including 31 cases in the resection group and 23 cases in the non-resection group. There were no statistical differences between the two groups in the baseline data such as age, gender, preoperative liver function indexes, and so on (P>0.05). The pancreaticojejunostomy leakage occurred in 7 cases (22.6%) of the resection group. The median follow-up time of the resection group and the non-resection group were 14 and 11 months. The median overall survival time of patients in the resection group and non-resection group were 18.0 months [95%CI (13.8, 22.1)] and 12.0 months [95%CI (8.2, 15.8)] respectively. The survival of the resection group was better than that of the non-resection group by log-rank test (χ²=4.074, P=0.045). Cox multivariate regression analysis result showed that the preoperative low albumin level (≤35.0 g/L), no perioperative chemotherapy, and no synchronous resection of hepatopancreas lesions shortened the overall survival time of patients with hepatic oligometastatic pancreatic cancer (P<0.05). For the patients who underwent the synchronous resection of hepatopancreas lesions, R0 resection and perioperative chemotherapy could prolong the overall survival time (P<0.05). Conclusions From the results of this study, synchronous resection of hepatopancreas lesions can benefit survival for patients with hepatic oligometastatic pancreatic cancer. The prognosis of patients without R0 resection and perioperative chemotherapy is even worse.

Citation： ZHONG Ming, WAN Wenwu, JIANG Ou, YAO Huihua, DING Bing. Synchronous resection of hepatopancreatic lesions in treatment of hepatic oligometastatic pancreatic cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1452-1457. doi: 10.7507/1007-9424.202203071 Copy

1.	Chen X, Yi B, Liu Z, et al. Global, regional and national burden of pancreatic cancer, 1990 to 2017: results from the Global Burden of Disease Study 2017. Pancreatology, 2020, 20(3): 462-469.
2.	De Dosso S, Siebenhüner AR, Winder T, et al. Treatment landscape of metastatic pancreatic cancer. Cancer Treat Rev, 2021, 96: 102180. doi: 10.1016/j.ctrv.2021.102180.
3.	Tsilimigras DI, Brodt P, Clavien PA, et al. Liver metastases. Nat Rev Dis Primers, 2021, 7(1): 27. doi: 10.1038/s41572-021-00261-6.
4.	Varghese AM, Lowery MA, Yu KH, et al. Current management and future directions in metastatic pancreatic adenocarcinoma. Cancer, 2016, 122(24): 3765-3775.
5.	Tachezy M, Gebauer F, Janot M, et al. Synchronous resections of hepatic oligometastatic pancreatic cancer: disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery, 2016, 160(1): 136-144.
6.	Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol, 2017, 43(2): 358-363.
7.	施思, 虞先濬. 胰腺癌肝转移的外科治疗: 实践中探索探索中前行. 中华外科杂志, 2021, 59(7): 593-596.
8.	白雪莉, 马涛, 梁廷波. 2016年NCCN胰腺癌临床实践指南(V1版)更新内容解读. 中国实用外科杂志, 2016, 36(8): 870-871.
9.	中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南(2021). 中华消化外科杂志, 2021, 20(7): 713-729.
10.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
11.	Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2. 2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2017, 15(8): 1028-1061.
12.	Oweira H, Petrausch U, Helbling D, et al. Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a Surveillance Epidemiology and End Results database analysis. World J Gastroenterol, 2017, 23(10): 1872-1880.
13.	Yang J, Zhang J, Lui W, et al. Patients with hepatic oligometastatic pancreatic body/tail ductal adenocarcinoma may benefit from synchronous resection. HPB (Oxford), 2020, 22(1): 91-101.
14.	Yu X, Gu J, Fu D, et al. Dose surgical resection of hepatic metastases bring benefits to pancreatic ductal adenocarcinoma? A systematic review and meta-analysis. Int J Surg, 2017, 48: 149-154.
15.	Zanini N, Lombardi R, Masetti M, et al. Surgery for isolated liver metastases from pancreatic cancer. Updates Surg, 2015, 67(1): 19-25.
16.	金添强, 戴朝六, 徐锋. 肝胰同步手术切除与全身化疗治疗可切除胰腺癌伴肝转移患者的效果比较. 临床肝胆病杂志, 2022, 38(3): 622-628.
17.	Liu M, Wang M, Li S. Prognostic factors of survival in pancreatic cancer metastasis to liver at different ages of diagnosis: a SEER population-based cohort study. Front Big Data, 2021, 4: 654972. doi: 10.3389/fdata.2021.654972.
18.	Du YQ, Bai XM, Yang W, et al. Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastasis from pancreatic adenocarcinoma. Int J Hyperthermia, 2022, 39(1): 517-524.
19.	Klein F, Puhl G, Guckelberger O, et al. The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract, 2012, 2012: 939350. doi: 10.1155/2012/939350.
20.	Shao Y, Feng J, Hu Z, et al. Feasibility of pancreaticoduodenectomy with synchronous liver metastasectomy for oligometastatic pancreatic ductal adenocarcinoma—a case-control study. Ann Med Surg (Lond), 2020, 62: 490-494.
21.	Crippa S, Bittoni A, Sebastiani E, et al. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol, 2016, 42(10): 1533-1539.
22.	Kandel P, Wallace MB, Stauffer J, et al. Survival of patients with oligometastatic pancreatic ductal adenocarcinoma treated with combined modality treatment including surgical resection: a pilot study. J Pancreat Cancer, 2018, 4(1): 88-94.
23.	Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg, 2019, 72: 156-165.
24.	Ji X, Zhao Y, He C, et al. Clinical effects of stereotactic body radiation therapy targeting the primary tumor of liver-only oligometastatic pancreatic cancer. Front Oncol, 2021, 11: 659987. doi: 10.3389/fonc.2021.659987.

1. Chen X, Yi B, Liu Z, et al. Global, regional and national burden of pancreatic cancer, 1990 to 2017: results from the Global Burden of Disease Study 2017. Pancreatology, 2020, 20(3): 462-469.
2. De Dosso S, Siebenhüner AR, Winder T, et al. Treatment landscape of metastatic pancreatic cancer. Cancer Treat Rev, 2021, 96: 102180. doi: 10.1016/j.ctrv.2021.102180.
3. Tsilimigras DI, Brodt P, Clavien PA, et al. Liver metastases. Nat Rev Dis Primers, 2021, 7(1): 27. doi: 10.1038/s41572-021-00261-6.
4. Varghese AM, Lowery MA, Yu KH, et al. Current management and future directions in metastatic pancreatic adenocarcinoma. Cancer, 2016, 122(24): 3765-3775.
5. Tachezy M, Gebauer F, Janot M, et al. Synchronous resections of hepatic oligometastatic pancreatic cancer: disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery, 2016, 160(1): 136-144.
6. Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol, 2017, 43(2): 358-363.
7. 施思, 虞先濬. 胰腺癌肝转移的外科治疗: 实践中探索探索中前行. 中华外科杂志, 2021, 59(7): 593-596.
8. 白雪莉, 马涛, 梁廷波. 2016年NCCN胰腺癌临床实践指南(V1版)更新内容解读. 中国实用外科杂志, 2016, 36(8): 870-871.
9. 中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南(2021). 中华消化外科杂志, 2021, 20(7): 713-729.
10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
11. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2. 2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2017, 15(8): 1028-1061.
12. Oweira H, Petrausch U, Helbling D, et al. Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a Surveillance Epidemiology and End Results database analysis. World J Gastroenterol, 2017, 23(10): 1872-1880.
13. Yang J, Zhang J, Lui W, et al. Patients with hepatic oligometastatic pancreatic body/tail ductal adenocarcinoma may benefit from synchronous resection. HPB (Oxford), 2020, 22(1): 91-101.
14. Yu X, Gu J, Fu D, et al. Dose surgical resection of hepatic metastases bring benefits to pancreatic ductal adenocarcinoma? A systematic review and meta-analysis. Int J Surg, 2017, 48: 149-154.
15. Zanini N, Lombardi R, Masetti M, et al. Surgery for isolated liver metastases from pancreatic cancer. Updates Surg, 2015, 67(1): 19-25.
16. 金添强, 戴朝六, 徐锋. 肝胰同步手术切除与全身化疗治疗可切除胰腺癌伴肝转移患者的效果比较. 临床肝胆病杂志, 2022, 38(3): 622-628.
17. Liu M, Wang M, Li S. Prognostic factors of survival in pancreatic cancer metastasis to liver at different ages of diagnosis: a SEER population-based cohort study. Front Big Data, 2021, 4: 654972. doi: 10.3389/fdata.2021.654972.
18. Du YQ, Bai XM, Yang W, et al. Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastasis from pancreatic adenocarcinoma. Int J Hyperthermia, 2022, 39(1): 517-524.
19. Klein F, Puhl G, Guckelberger O, et al. The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract, 2012, 2012: 939350. doi: 10.1155/2012/939350.
20. Shao Y, Feng J, Hu Z, et al. Feasibility of pancreaticoduodenectomy with synchronous liver metastasectomy for oligometastatic pancreatic ductal adenocarcinoma—a case-control study. Ann Med Surg (Lond), 2020, 62: 490-494.
21. Crippa S, Bittoni A, Sebastiani E, et al. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol, 2016, 42(10): 1533-1539.
22. Kandel P, Wallace MB, Stauffer J, et al. Survival of patients with oligometastatic pancreatic ductal adenocarcinoma treated with combined modality treatment including surgical resection: a pilot study. J Pancreat Cancer, 2018, 4(1): 88-94.
23. Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg, 2019, 72: 156-165.
24. Ji X, Zhao Y, He C, et al. Clinical effects of stereotactic body radiation therapy targeting the primary tumor of liver-only oligometastatic pancreatic cancer. Front Oncol, 2021, 11: 659987. doi: 10.3389/fonc.2021.659987.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Synchronous resection of hepatopancreatic lesions in treatment of hepatic oligometastatic pancreatic cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content