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15.04.2019 | main topic | Ausgabe 3/2019 Open Access

European Surgery 3/2019

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

Zeitschrift:
European Surgery > Ausgabe 3/2019
Autoren:
Willem Niesen, Florian Primavesi, Silvia Gasteiger, John Neoptolemos, Thilo Hackert, PD Dr. Stefan Stättner
Wichtige Hinweise
Willem Niesen and Florian Primavesi contributed equally to the manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Summary

Background

Pancreatic cancer (PC) remains a disease characterized by an extremely poor prognosis, which is often limited by advanced tumor stage at diagnosis. As surgery remains the only option for long-term survival, indications for resection to achieve a complete tumor removal have been extended in recent years, including locally advanced as well as metastatic disease.

Methods

Here, we provide a literature overview of modern multimodal treatment concepts of metastatic PC focused on surgery and local interventions including neoadjuvant concepts, stratification of patients, prognostic parameters, and oncological outcomes.

Results

The current literature lacks level I evidence studies on surgery in stage IV PC. The available observational studies show that resection for liver metastasis has been increasingly performed in recent years, outcomes improve after neoadjuvant therapy, and certain prognostic parameters can identify patients who benefit from this approach. In addition, interventional or radio-oncological liver-directed therapies have been evaluated showing the possibility of some disease control. Resection of pulmonary metastases is rarely performed, although this patient subgroup may have a more favorable prognosis than patients with stage IV liver cancer. Surgery in the setting of peritoneal carcinomatosis remains experimental without any valid supporting data.

Conclusions

There are promising data to support resection of metastatic PC, presuming this approach is embedded in a multimodal oncological concept with modern and effective multi-agent chemotherapies and proper patient selection. Based on this, future studies should specify distinct groups of patients who benefit from extended surgical approaches including synchronous or staged metastasectomy.

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