Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival?

To determine whether aggressive surgery, consisting of a simultaneous pancreatic and partial hepatic resection, for patients with an invasive metastatic ductal adenocarcinoma of the pancreatic head improves the postoperative outcome.

A total of 109 patients with adenocarcinoma of the pancreatic head were divided into two groups. Group 1 consisted of 33 patients with liver metastasis and Group 2 consisted of 76 patients without liver metastasis. Group 1 was further subdivided into 11 patients(Group 1-A) to aggressive surgery, consisting of pancreatoduodenectomy and partial liver resection, and 22 patients to palliative bypass surgery(group 1-B). Group 2 was subdivided into 37 patients to pancreatoduodenectomy(group 2-A), and 39 patients to bypass surgery(group 2-B).

No significant statistical differences were seen in the outcomes between Group 1-A (median survival period: 6 months) and Group 1-B (median survival period: 4 months). Further, all Group 1-A patients died from multiple recurrent liver metastasis within a year. In addition, the outcomes of Group 1-A were significantly poorer than that of 2-A patients(median survival period: 24 months).

Patients who underwent an aggressive simultaneous resection of primary and metastatic hepatic lesion did not exhibit any improvement. However, it is anticipated that these findings will provide insights into developing an effective adjuvant therapy to impede or destroy macroscopic/occult liver metastasis.