HPB Surgical Unit, Pederzoli Hospital, Verona, Italy.
General Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Ann Surg Oncol. 2017 Aug;24(8):2397-2403. doi: 10.1245/s10434-017-5885-4. Epub 2017 May 17.
Recent papers consider surgery as an option for synchronous liver oligometastatic patients [metastatic pancreatic ductal adenocarcinoma (mPDAC)]. In this study, we present our series of resected mPDACs after neoadjuvant chemotherapy (nCT).
All patients resected after downstaging of mPDAC were included in this study. Downstaging criteria were disappearance of liver metastasis and a decrease in cancer antigen (CA) 19-9. The type and duration of nCT, last nCT surgery interval, histology, morbidity, and mortality were recorded, and overall survival (OS) and disease-free survival (DFS) were analyzed.
Overall, 24 of 535 patients (4.5%) observed with mPDAC were included. These patients received gemcitabine alone (5/24), gemcitabine + nanoparticle albumin-bound (nab)-paclitaxel (3/24), and FOLFIRINOX (16/24). Primary tumor size decreased from 31 to 19 mm (p < 0.001), and serum CA19-9 decreased from 596 to 18 U/mL (p < 0.001). In 14/24 patients, the tumor was located in the head. Median interval nCT surgery was 2 months, there were no mortalities, and the postoperative course was uneventful in 34% of cases. Grade B/C pancreatic fistula, postoperative bleeding, and sepsis occurred in 17/4, 4, and 12% of cases, respectively, and reoperation rate was 4%. R0 resection was achieved in 88% of cases, with 17% complete pathological response. Positive nodes were found in 9/24 patients with a median node ratio of 0.37, and OS and DFS was 56 and 27 months, respectively.
Patients with mPDAC who were fully responsive to nCT may be cautiously considered for surgery, with potential benefit in survival compared with palliative chemotherapy alone. This is supported by results of our retrospective study, which is the largest ever reported.
最近的一些论文认为手术是同步肝寡转移患者[转移性胰腺导管腺癌（mPDAC）]的一种治疗选择。在本研究中，我们报告了接受新辅助化疗（nCT）后切除的 mPDAC 系列病例。
所有 mPDAC 降期后接受切除术的患者均纳入本研究。降期标准为肝转移灶消失和肿瘤标志物（CA）19-9 降低。记录 nCT 的类型和持续时间、末次 nCT 手术间隔、组织学、发病率和死亡率，并分析总生存（OS）和无病生存（DFS）。
共有 535 例 mPDAC 患者中，有 24 例（4.5%）被纳入。这些患者接受吉西他滨单药治疗（5/24）、吉西他滨+白蛋白结合型紫杉醇（nab-紫杉醇）（3/24）和 FOLFIRINOX（16/24）。原发肿瘤大小从 31 毫米降至 19 毫米（p<0.001），血清 CA19-9 从 596 降至 18 U/mL（p<0.001）。在 14/24 例患者中，肿瘤位于头部。nCT 手术的中位间隔为 2 个月，无死亡病例，34%的病例术后过程顺利。B/C 级胰瘘、术后出血和脓毒症分别发生在 17/4、4 和 12%的病例中，再次手术率为 4%。88%的患者达到了 R0 切除，其中 17%达到完全病理缓解。24 例患者中有 9 例发现阳性淋巴结，淋巴结比值中位数为 0.37，OS 和 DFS 分别为 56 个月和 27 个月。
对 nCT 完全有反应的 mPDAC 患者可谨慎考虑手术治疗，与单纯姑息性化疗相比，可能有生存获益。这一结论得到了我们回顾性研究结果的支持，这是迄今为止报告的最大规模研究。
