Background: The value of liver resection (LR) for metachronous pancreatic ductal adenocarcinoma
(PDAC) metastases remains controversial. However, in light of increasing safety of
liver resections, surgery might be a valuable option for metastasized PDAC in selected
patients. Methods: We performed a retrospective, multicenter study including patients
undergoing hepatectomy for metachronous PDAC liver metastases between 2004 and 2015
to analyze postoperative outcome and overall survival. All patients were operated
with curative intent. Patients with oligometastatic metachronous liver metastasis
with definitive chemotherapy (n = 8) served as controls. Results: Overall 25 patients
in seven centers were included in this study. The median age at the time of LR was
63.8 years (56.9-69.9) and the median number of metastases in the liver was 1 (IQR
1-2). There were eight non anatomical resections (32%), 15 anatomical minor (60%)
and 2 major LR (8%). Postoperative complications occurred in eleven patients (eight
Clavien-Dindo grade I complications (32%) and three grade IIIa complications (12%),
respectively). The 30-day mortality was 0%. The median length of stay was 8.6 days
(IQR 5-11). Median overall survival following LR was 36.8 months compared to 9.2 months
in patients with metachronous liver metastasis with chemotherapy (p = 0007). Discussion:
Liver resection for metachronous PDAC metastasis is safe and feasible in selected
patients. To address general applicability and to find factors for patient selection,
larger trials are urgently warranted.
