Pulmonary metastasectomy for suspected pancreaticobiliary cancer

Occasionally, pancreaticobiliary cancer presents as a relatively indolent disease and localized blood-borne lung metastases may be resectable. We reviewed our experience with therapeutic lung resections in pancreatic cancer patients.

In a retrospective cohort study of pancreatic cancer patients who underwent subsequent therapeutic lung resections, from 1996 to 2015, all clinical data were gathered for comparison between patients undergoing pancreatic pulmonary metastasectomy and those undergoing lung resection for other diseases.

Among 29 patients with definitively treated pancreaticobiliary cancer who underwent lung resections with curative intent, 16 patients (55%) had resection of isolated pancreaticobiliary cancer metastases (group A) and 13 patients (45%) had 15 resections of primary lung cancers, and one granuloma (group B). No surgical complications or operative mortalities occurred. The median disease-free interval (DFI) from definitive pancreatic cancer treatment to pulmonary metastasectomy or other nonmetastasectomy therapeutic lung resection was 24.0 and 8.0 months, respectively. The estimated median overall survival after lung resection was 33 months for all patients (95% confidence interval: 0, 67) and 28 months for the group A pulmonary metastasectomy patients (95% confidence interval: 16, 40), corresponding to an estimated 5-year survival rate of 47% and 37%, respectively. Serum CA 19-9 level before lung resection significantly predicted mortality: adjusted hazard ratio 1.38 (95% confidence interval: 1.09, 1.74) per each 100-unit increment, P = .006.

Although pancreaticobiliary cancers have an overall dismal prognosis, we recommend pulmonary metastasectomy in highly selected patients. Additionally, not all new lung masses in pancreatic cancer patients are metastases, and resection should be considered, for a second primary lung cancer is often found.