Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1512-1521
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1512
Resection of isolated liver oligometastatic disease in pancreatic ductal adenocarcinoma: Is there a survival benefit? A systematic review
James M Halle-Smith, Sarah Powell-Brett, Keith Roberts, Nikolaos A Chatzizacharias
James M Halle-Smith, Sarah Powell-Brett, Keith Roberts, Nikolaos A Chatzizacharias, Department of HPB and Liver Transplant, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2GW, United Kingdom
Author contributions: Halle-Smith JM and Powell-Brett S performed the literature search, data collection and initial manuscript preparation; Roberts K and Chatzizacharias NA wrote and reviewed the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos A Chatzizacharias, MD, PhD, FRCS, FACS, Consultant Surgeon, Department of HPB and Liver Transplant, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. nikolaos.chatzizacharias@uhb.nhs.uk
Received: January 26, 2023
Peer-review started: January 26, 2023
First decision: February 7, 2023
Revised: February 22, 2023
Accepted: May 5, 2023
Article in press: May 5, 2023
Published online: July 27, 2023
ARTICLE HIGHLIGHTS
Research background

Pancreatic ductal adenocarcinoma (PDAC) remains a leading cause of cancer death globally, with a substantial number of patients presenting with metastatic disease and typical survival of less than 12 mo. Furthermore, up to 75% of patients who undergo surgical resection and adjuvant therapy for primary PDAC will experience disease recurrence within 2 years and two thirds of those will have metastatic disease. International practice guidelines consistently suggest palliative treatment pathways for these patients. Nonetheless, there is an increasing body of evidence in the form of small case series and reports that present promising oncological outcomes following resection of metachronous and even synchronous isolated liver metastases from PDAC primary.

Research motivation

A number of patients with oligometastatic disease may benefit from an aggressive approach which includes surgical resection.

Research objectives

The aim of this systematic review is to present the published evidence on the surgical management of PDAC isolated liver metastases, synchronous and metachronous; and compare the outcomes to the current standard of care (palliative treatment).

Research methods

A systematic literature search was performed for studies reporting outcomes of resection of isolated liver metastases in patients with PDAC, in either a synchronous or metachronous setting, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Synchronous lesions were defined those appearing within 6 mo of the primary diagnosis, whilst metachronous those diagnosed after 6 mo. The primary endpoint for this systematic review was median overall survival in PDAC patients with synchronous or metachronous isolated liver metastases treated with either surgical resection or an alternative treatment modality, for example chemotherapy. Secondary outcomes included disease free survival, peri-operative morbidity and mortality.

Research results

The literature search identified a total of 356 studies, of which 31 full-text articles were screened and of these 10 articles were suitable for inclusion with a total of 449 patients. Nine studies reported outcomes of surgical resection for synchronous isolated liver metastases and 4 reported outcomes for resection of metachronous metastases (3 studies reported outcomes for both).

Research conclusions

In conclusion, the evidence on surgical management of PDAC isolated liver metastases is scarce and inconclusive. A survival benefit may exist in selected metachronous cases when disease biology has been tested with time and systemic treatment. 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.

Research perspectives

Future studies should focus on pathways for selection of cases that may benefit from an aggressive approach, including patient selection, tumour genetic testing and individualised systemic treatment, as well as novel markers for treatment response.