Department of General, Visceral, and Transplantation Surgery, Hospital of the University of Munich, Ludwig-Maximilians-University Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
Department of General, Visceral, and Transplantation Surgery, Hospital of the University of Munich, Ludwig-Maximilians-University Munich, Germany.
Surg Oncol. 2019 Dec;31:16-21. doi: 10.1016/j.suronc.2019.08.010. Epub 2019 Aug 26.
To assess the perioperative and long-term outcome following pulmonary resection in patients with metachronous metastasis of pancreatic ductal adenocarcinoma (PDAC).
Most patients with PDAC relapse or develop tumor spread to secondary organs. Currently, it remains unclear how to proceed with pulmonary metastasis in the metachronous setting. In particular, the role of surgery remains controversial.
Data of patients with pulmonary metachronous metastasis after PDAC collected from 2003 to 2015 in databases of two high-volume pancreatic cancer centers were retrospectively analyzed. Clinical and pathological aspects of primary PDAC as well as the perioperative and long-term outcome following pulmonary metastasectomy (PM) was evaluated, respectively. Patients with synchronous liver metastasis or metastasis to other secondary organs were excluded. Univariate survival analysis was performed.
We identified 15 patients undergoing pulmonary resection for suspected metastasis after primary pancreatic resection. Operative and histopathologic evaluation revealed resectable pancreatic pulmonary metastasis in 11 patients (73.3%). The median disease-free survival (DFS) and overall survival (OS) after PM diagnosis was 18 months and 26 months, respectively. The median time to metachronous metastasis (TMM) was 17 months [3-64 months]. Perioperative morbidity was low with only one readmission (8.3%). There was no perioperative mortality. Patients who developed pulmonary metastasis later than 17 months after primary surgery showed better OS compared to those who did earlier (32.2 vs. 14.75 months, p = 0.025). In addition, patients with high-grade tumors had worse survival (12.4 vs. 31 months, p = 0.02). Elevated serum CEA levels or CA 19-9 levels were also not associated with shortened OS.
This study suggests that pulmonary metastasectomy after PDAC is safe and effective. Patients with extended DFS after primary pancreatic surgery as well as favorable tumor grading seem to particularly benefit from pulmonary surgery.
评估胰腺导管腺癌（PDAC）患者异时性转移后行肺切除术的围手术期和长期结果。
大多数 PDAC 患者会复发或发生肿瘤扩散至次级器官。目前，对于异时性肺转移的处理方式尚不清楚。特别是，手术的作用仍存在争议。
回顾性分析 2003 年至 2015 年两个大容量胰腺肿瘤中心数据库中收集的 PDAC 后发生肺异时性转移的患者数据。评估了 PDAC 原发灶的临床和病理特征，以及肺转移瘤切除术（PM）后的围手术期和长期结果。排除了同时伴有肝转移或转移至其他次级器官的患者。进行了单因素生存分析。
我们共识别出 15 例在胰腺切除术后因疑似转移而行肺切除术的患者。手术和组织病理学评估显示 11 例（73.3%）患者存在可切除的肺胰转移瘤。PM 诊断后的中位无病生存期（DFS）和总生存期（OS）分别为 18 个月和 26 个月。异时性转移（TMM）的中位时间为 17 个月[3-64 个月]。围手术期发病率较低，仅有 1 例再入院（8.3%）。无围手术期死亡。与早期（17 个月内）发生肺转移的患者相比，晚期（17 个月后）发生肺转移的患者 OS 更好（32.2 与 14.75 个月，p=0.025）。此外，高级别肿瘤患者的生存情况较差（12.4 与 31 个月，p=0.02）。血清 CEA 或 CA 19-9 水平升高也与 OS 缩短无关。
本研究表明，PDAC 后行 PM 是安全有效的。在胰腺原发手术后 DFS 延长且肿瘤分级良好的患者中，肺手术尤其有益。
