Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2018; 24(33): 3677-3680
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3677
Time to think: Selecting patients who may benefit from synchronous resection of primary pancreatic cancer and liver metastases
Si Shi, Xian-Jun Yu
Si Shi, Xian-Jun Yu, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Si Shi, Xian-Jun Yu, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Si Shi, Xian-Jun Yu, Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
Author contributions: Shi S and Yu XJ conceived the study and drafted the manuscript; both authors approved the final version of the article.
Supported by the National Science Foundation for Distinguished Young Scholars of China, No. 81625016; and the Shanghai Sailing Program, No. 17YF1402500.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xian-Jun Yu, MD, PhD, Professor, Surgeon, Surgical Oncologist, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai 200032, China. yuxianjun@fudanpci.org
Telephone: +86-21-64175590 Fax: +86-21-64031446
Received: June 16, 2018
Peer-review started: June 17, 2018
First decision: July 6, 2018
Revised: July 11, 2018
Accepted: July 22, 2018
Article in press: July 22, 2018
Published online: September 7, 2018
Processing time: 82 Days and 11.7 Hours
Abstract

Pancreatic cancer remains a lethal disease and is associated with poor prognosis, particularly for patients with distant metastasis at diagnosis. Recently, Oweira reported a retrospective study that included 13233 metastatic pancreatic cancer patients from the Surveillance, Epidemiology and End Results database. They demonstrated that pancreatic cancer patients with isolated liver metastases had worse outcomes than patients with isolated lung metastases or distant nodal metastases. At present, the standard treatment for metastatic pancreatic cancer is chemotherapy. However, improvement in the safety of pancreatic surgery has led to the consideration of more aggressive surgical approaches. Schneitler reported two cases of hepatic metastatic pancreatic cancer in which negative margin (R0) resection and long survival were achieved after effective preoperative chemotherapy. In general, these two studies indicate that although pancreatic cancer patients with liver metastasis have a poor prognosis, surgical approaches may prolong survival for a few of these patients. A strategy to select hepatic metastatic pancreatic cancer patients who may benefit from surgical intervention is urgently needed.

Keywords: Liver metastasis; Chemotherapy; Pancreatic cancer; Surgery

Core tip: Pancreatic cancer patients with liver metastasis have worse prognoses than pancreatic cancer patients with metastasis at other sites. Improvement in the safety of pancreatic surgery has led to the consideration of more aggressive approaches. There is increasing agreement that synchronous resection of pancreatic cancer and liver metastases may selectively benefit some patients. A prospective multicenter, randomized, controlled phase three trial has been launched by the Chinese Study Group for Pancreatic Cancer with a goal of establishing such a selection strategy.