Outcomes of pancreaticoduodenectomy in patients with metastatic cancer

Metastatic cancer of pancreas is rarely resectable. Pancreaticoduodenectomy carries high risks of morbidities and mortalities that it is rarely performed for metastatic cancer. In this study, the clinical features and outcomes of metastatic cancer of pancreas after pancreaticoduodenectomy were reviewed and analyzed.

We retrospectively reviewed patients who underwent pancreaticoduodectomy from January 2000 to December 2012 in Samsung Medical Center. A total of 1045 patients were enrolled in this study. Inclusion criteria were patients who had metachronous lesions with tumors histologically confirmed as metastatic cancer. However, patients with tumors directly invaded pancreas head, bile duct, and duodenum were excluded from this study. Finally, a total of 12 patients who underwent pancreaticoduodenectomy due to metastatic cancer were used in this study. Clinicopathologic features and perioperative data of these 12 patients were retrospectively reviewed.

The 12 patients included 6 females and 6 males who had metastatic lesions at pancreas head, duodenum 2nd-3rd portion, and distal common bile duct. The mean age of patients was 62.7 years old at the time of pancreaticoduodenectomy. The interval between the time of the first operation for primary cancer and pancreaticoduodenectomy was 67.7 months. The mean survival time after pancreaticoduodectomy was 38.6 months (range, 12 to 119 months). There was no fatal complication after the surgery.

Pancreaticoduodenectomy is becoming a safer procedure with less complication compared to the past. Patients with recurrent metastatic cancer should be considered for metastectomy if tumors are resectable. Pancreaticoduodenectomy should be considered as one main treatment for patients with recurrent metastatic cancer to offer a chance of long-term survival in selected patients.