Surgery in Oligometastatic Pancreatic Cancer: Narrative Systematic Review

Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, particularly in metastatic disease where surgical resection is traditionally not recommended. However, the concept of oligometastatic disease-characterized by limited metastatic spread with a presumed more favorable oncological prognosis-has prompted reconsideration of metastasis-directed therapies, including surgery, in carefully selected patients.

A selective literature review was conducted using PubMed to identify studies reporting surgical treatment for oligometastatic PDAC, including synchronous or metachronous metastases. Studies were included if they reported outcomes after resection of the primary tumor and/or metastatic lesions in patients with limited metastatic burden. Results were presented in a narrative way.

Retrospective studies suggest that surgical resection of the primary tumor and metastases may be feasible, safe and associated with prolonged survival in selected patients with oligometastatic PDAC. Favorable prognostic factors across studies include response to systemic chemotherapy prior to resection, low tumor marker levels, limited number of metastases, and the possibility of achieving complete macroscopic resection. Patients with isolated pulmonary metastases appear to have particularly favorable outcomes. However, existing evidence is derived exclusively from retrospective analyses and is subject to considerable selection bias.

Current evidence indicates that surgery for oligometastatic PDAC may benefit highly selected patients within a multimodal treatment strategy. The results of ongoing prospective and randomized clinical trials are expected to clarify the role of surgery in this setting. Until these results become available, treatment decisions should be individualized and made within multidisciplinary tumor boards.