Pancreatic, periampullary and biliary cancer with liver metastases: Should we consider resection in selected cases?

Table 1 Studies for pancreatic cancer

	n	Age	No. of hepatic metastases	Median size of liver metastases	Chemotherapy	Mortality rate
Hackert et al[39], 2017	85	60	96% had 3 lesions 3 had > 3 lesions	31% had 1-2 cm 43% had < 1 cm	74% received Adjuvant gemcitabine or 5 FU	2.90%
Crippa et al[34], 2016	11	65 (35-80)	10% had 1 28% had 1-5 61% had > 5	NA	Neoadjuvant gemcitabine (14%), 30% gemcitabine + nab-paclitaxel while 66% had FOLFIRINOX, PEFG, PEXG or PDXG	0
Tachezy et al[38], 2016	69	65 (31-83)	2 (1-11)	NA	Neoadjuvant gemcitabine in 4% or FOLFIRINOX in 14%. Adjuvant in 80%, 80% got gemcitabine and 7% FOLFIRINOX	1%
Zanini et al[35], 2015	15	55 (52-64)	2 (1-3) 60% had 1 lesion	2.2 cm (1.8-2.5)	Adjuvant gemcitabine	0
Klein et al[33], 2012	22	57.5 (31-78)	NA	NA	Adjuvant gemcitabine	0
Dünschede et al[40], 2010	9	55 (39-72)	3 (1-5)	3.5 (1-9)		0
Gleisner et al[37], 2007	17	64.7 ± 11.4	1 (1-1)	0.6 (0.3-1.2)	6 received 5FU or gemcitabine	9.10%
Shrikhande et al[36], 1996	11	65 (60-74)	2 (1-3)	NA	Adjuvant Gemcitabine or 5FU or radiation	0

5FU: Fluorouracil; FOLFIRINOX: Oxaliplatin, irinotecan, fluorouracil and leucovorin, cisplatin; PEXG: Gemcitabine plus capecitabine and epirubicin; PDXG: Capecitabine and docetaxel; PEFG: Epirubicin and fluorouracil; NA: Not available.

Table 2 Results by outcome for pancreatic cancer

	N	Median OS(mo)	95%CI	N	Median OS (mo)	95%CI	P-value
	Resection			No resection
Positive studies
Hackert et al[39]	85	12.3		NA
Tachezy et al[38]	69	14	10.8-18.2	69	7.5	4.9–10.2	< 0.001
Crippa et al[34]	11	39		116	11		< 0.0001
Klein et al[33]	22	16.6		NA
Yamada et al[75]	11	10.1		28	6.8		NS
Shrikhande et al[36]	11	11.4	7.8-16.5	118	5.9	5.4-7.6	0.04
Negative studies
Zanini et al[35]	15	9.1	8.6-9.7	NA
Dünschede et al[40]	9	8 (4-16)		5	11 (10-12)
Gleisner et al[37]	22	5.9		66	5.6		0.46
Takada et al[42]	11	6 (2-10)		33	3 (2-9)

NA: Not available; NS: Not significant.

Table 3 Studies for biliary tract cancer

	N	Age (yr)	No. and size of hepatic metastases	Treatment	Median OS (mo)	Mortality Rate	Survival rate %
Kurosaki et al[47], 2011	Distal bile duct (n = 7) Ampullary cancer (n = 6)	65 ± 10	Median no = 2 (1-3) Median size 3 cm (1.8-6 cm)	Adjuvant cisplatin + 5 FU or gemcitabine or S1 (n = 10)	Bile duct = 14 Ampullary = 20	-	5-yr = 44.9%
Bresadola et al[49], 2011	Gall bladder (n = 5) Papilla of Vater (n = 3) Biliary tract (n = 1)	56 (46-64)	-	-	Gall bladder = 5 (1-12) Papilla of Vater = 7 (5-71) Biliary tract = 17	3%
de Jong et al[48], 2010	Ampullary (n = 10) Duodenal (n = 5) Biliary (n = 5) Pancreas (n = 20)	63.0 ± 10.6	Median no 1(1-5) and median size 0.7 (0.2-5.9)	Neoadjuvant chemotherapy (pancreatic n = 4 ampullary n = 2 duodenal n = 1) Adjuvant chemotherapy n = 22 (55%) Gemcitabine (n = 14) 5-fluruoracil (n = 4), cyclophosphamide (n = 2) Combination irinotecan (n = 3)	Intestinal type = 23 Pancreatobiliary = 13	5%	3-yr survival Intestinal tumours = 33% Pancreatobiliary tumours = 8%
Wakai et al[45], 2008	Extrahepatic cholangiocarcinoma; adeno- carcinoma (n = 2) Gall bladder; adeno-squamous (n = 1)	63 (35-79)	-	-	Bile duct = 8 and 15 gall Bladder = 9	21%	5 yr = Extra hepatic 12% Gall bladder 9%
Gleisner et al[37], 2007	Ampullary (n = 1) Duodenal (n = 2) Distal bile duct (n = 2) Histology Adenocarcinoma	65(53–82)	Median no = 1 and median size 0.6 cm (0.3-1.2)	FOLFIRI given to duodenal cancer	9.9	9.10%	3 yr = 6.7%
Adam et al[13], 2006	Ampullary (n = 15) Pancreatic (n = 41) Gallbladder (n = 23) Biliary (n = 5)	53 (10-87)	-	-	Ampullary = 38	-	5 yr Ampullary = 46% The entire cohort = 27%
Fuji et al[46], 1999	Bile duct (n = 2) (adenocarcinoma) Ampulla of vater (n = 2) Duodenal cancer (n = 3)	58 (36-67)	Median no = 1	-	20	-	3 yr = 28%

Table 4 Results by outcome for biliary tract cancer

	N	Median OS (mo)	95%CI	N	Median OS (mo)	95%CI
	Resection			No resection or palliative surgery
Positive studies
Fujii et al[46]	7	20		NA
Kurosaki et al[47]	13	28-60		9	6-12
Niguma et al[50]	10	17.2		12	4.4
de Jong et al[48]	8	17-19		7	7	< 0.01
Adam et al[13]	15	38		NA
Negative studies
Gleisner et al[37]	5	9.9			6	0.43
Wakai et al[45]	3	9		NA
Bresadola et al[49]	7	15		NA

NA: Not available.