Halle-Smith James M, Powell-Brett Sarah, Roberts Keith, Chatzizacharias Nikolaos A
Department of HPB and Liver Transplant, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2GW, United Kingdom.
World J Gastrointest Surg. 2023 Jul 27;15(7):1512-1521. doi: 10.4240/wjgs.v15.i7.1512.
Presence of liver metastatic disease in pancreatic ductal adenocarcinoma (PDAC), either synchronous or metachronous after pancreatic resection, is a terminal diagnosis that warrants management with palliative intent as per all international practice guidelines. However, there is an increasing interest on any potential value of surgical treatment of isolated oligometastatic disease in selected cases.
To present the published evidence on surgical management of PDAC liver metastases, synchronous and metachronous, and compare the outcomes of these treatments to the current standard of care.
A systematic review was performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to compare the outcomes of both synchronous and metachronous liver metastases resection to standard care.
356 studies were identified, 31 studies underwent full-text review and of these 10 were suitable for inclusion. When synchronous resection of liver metastases was compared to standard care, most studies did not demonstrate a survival benefit with the exception of one study that utilised neoadjuvant treatment. However, resection of metachronous disease appeared to confer a survival advantage when compared to treatment with chemotherapy alone.
A survival benefit may exist in resection of selected cases of metachronous liver oligometastatic PDAC disease, after disease biology has been tested with time and systemic treatment. Any survival benefit is less clear in synchronous cases; however an approach with neoadjuvant treatment and consideration of resection in some selected cases may confer some benefit. Future studies should focus on pathways for selection of cases that may benefit from an aggressive approach.
胰腺导管腺癌（PDAC）中存在肝转移疾病，无论是在胰腺切除术后同步出现还是异时出现，均为终末期诊断，根据所有国际实践指南，都应以姑息治疗为目的进行处理。然而，对于某些选定病例中孤立性寡转移疾病的手术治疗的任何潜在价值，人们的兴趣与日俱增。
介绍已发表的关于PDAC肝转移（同步和异时）手术管理的证据，并将这些治疗的结果与当前的标准治疗进行比较。
根据系统评价和Meta分析的首选报告项目指南进行系统评价，以比较同步和异时肝转移切除与标准治疗的结果。
共识别出356项研究，31项研究进行了全文审查，其中10项适合纳入。当将肝转移的同步切除与标准治疗进行比较时，除了一项采用新辅助治疗的研究外，大多数研究未显示出生存获益。然而，与单纯化疗相比，异时性疾病的切除似乎具有生存优势。
在经过时间和全身治疗检验疾病生物学特性后，对某些选定的异时性肝寡转移PDAC病例进行切除可能存在生存获益。在同步病例中，任何生存获益都不太明确；然而，新辅助治疗并在某些选定病例中考虑切除的方法可能会带来一些益处。未来的研究应关注可能从积极治疗方法中获益的病例选择途径。
