Scientific Letter
Increased Survival After Resection of Pancreatic Cancer Liver Metastases
Supervivencia prolongada tras resección de metástasis hepáticas de adenocarcinoma de páncreas
José Manuel Lorente-Herce
, Pablo Parra-Membrives, Daniel Díaz-Gómez, Darío Martínez-Baena, Macarena Márquez-Muñoz, Francisco Javier Jiménez-Vega
Corresponding author
Unidad de Gestión Clínica, Enfermedades Digestivas, Hospital Universitario Virgen de Valme, Sevilla, Spain
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Metastases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "390" "paginaFinal" => "392" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Manuel Lorente-Herce, Pablo Parra-Membrives, Daniel Díaz-Gómez, Darío Martínez-Baena, Macarena Márquez-Muñoz, Francisco Javier Jiménez-Vega" "autores" => array:6 [ 0 => array:4 [ "nombre" => "José Manuel" "apellidos" => "Lorente-Herce" "email" => array:1 [ 0 => "lorente82@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Pablo" "apellidos" => "Parra-Membrives" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Díaz-Gómez" ] 3 => array:2 [ "nombre" => "Darío" "apellidos" => "Martínez-Baena" ] 4 => array:2 [ "nombre" => "Macarena" "apellidos" => "Márquez-Muñoz" ] 5 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Jiménez-Vega" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica, Enfermedades Digestivas, Hospital Universitario Virgen de Valme, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Supervivencia prolongada tras resección de metástasis hepáticas de adenocarcinoma de páncreas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 701 "Ancho" => 900 "Tamanyo" => 97034 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography after pancreaticoduodenectomy showing liver metastasis of pancreatic adenocarcinoma (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The prognosis for pancreatic adenocarcinoma has changed very little in recent decades and still continues to be dismal. It has been demonstrated that surgical resection is the only therapeutic option that is able to achieve greater long-term survival (18% 5-years post-pancreaticoduodenectomy [PD], and only 12% when there are metastases in the regional lymph nodes).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Using these data, pancreatic resection is traditionally considered contraindicated when there are synchronous liver metastases at the time of surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of long-term survival after PD with simultaneous resection of synchronous liver metastases and deferred surgery for multiple metachronous liver metastases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 38-year-old male with no prior medical history came to our emergency department in December 2006 with weight loss, jaundice and abdominal pain in the upper right abdominal quadrant. Computed tomography (CT) detected a space-occupying lesion measuring 15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm at the head of the pancreas, with no suspicion of extra-pancreatic disease. A malignant lesion was suspected, and a PD was proposed. During the surgery, a solitary superficial lesion in the liver was biopsied. As the intraoperative histopathologic study ruled out malignancy, we proceeded with the standard Whipple procedure. The postoperative period was uneventful, and the definitive pathology analysis reported ductal adenocarcinoma of the head of the pancreas measuring 25<span class="elsevierStyleHsp" style=""></span>mm with moderate differentiation (pT2), and absence of pathologic lymph nodes (pN0). The differed study of the biopsied liver nodule revealed the presence of pancreatic metastatic tumor cells. In a follow-up control in June 2007, 7 hepatic metastases were detected in segments <span class="elsevierStyleSmallCaps">ii</span> (×1), <span class="elsevierStyleSmallCaps">iii</span> (×3), <span class="elsevierStyleSmallCaps">iv</span> (×1), <span class="elsevierStyleSmallCaps">v</span> (×1) and <span class="elsevierStyleSmallCaps">viii</span> (×1) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and chemotherapy was therefore initiated with gemcitabine and capecitabine as palliative treatment. The patient presented good response to the protocol, with partial regression of the hepatic metastases and persistence of only 2 lesions in a CT done in November 2008. Given this situation, we re-considered the therapeutic strategy, and rescue surgery was proposed. During laparotomy, 6 subcentimeter metastases (segments <span class="elsevierStyleSmallCaps">ii, iii, iv, v, viii</span>) were identified and resected. In addition, a larger lesion was detected in the <span class="elsevierStyleSmallCaps">iv</span>b-<span class="elsevierStyleSmallCaps">v</span> segment, which was treated by means of radiofrequency ablation. The pathology study demonstrated the presence of pancreatic adenocarcinoma in all the resected lesions. The patient remained disease-free for 50 months after the pancreatic resection, 28 months after the second hepatic surgery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In April 2011, a follow-up CT detected multiple bilateral subcentimeter liver metastases. Since then, the patient has been treated with a 15-day regimen of gemcitabine and cisplatin that maintains the disease stable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The current situation of hepatic resection due to colorectal or neuroendocrine metastases is well defined. In contrast, the effectiveness of hepatic surgery for liver metastases whose primary origin is that of different locations or different histologic origins is controversial. In spite of the fact that hepatic resection due to metastases of non-colorectal or neuroendocrine origin is gaining popularity and the number of patients who are being resected is increasing,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> few studies support surgery for liver metastasis of pancreatic cancer. Based on recently published data, the observed overall survival ranges between 5.9 and 8.3 months after the resection of synchronous metastases and 5.8 to 20 months for the resection of metachronous metastases.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> Meanwhile, chemotherapy for advanced pancreatic cancer has undergone few changes since the approval of gemcitabine.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Only 2 combinations (erlotinib<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>gemcitabine and gemcitabine<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>capecitabine) have been shown to increase survival, despite the many trials done with gemcitabine and other chemotherapy drugs.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> The choice of one or the other drug combination is mainly based on the balance between toxicity and benefit. In our case, age and the absence of comorbidities enabled us to select a combination of gemcitabine and capecitabine, which was able to stabilize the metastatic disease and significantly improve survival.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Some centers recommend PD as a palliative procedure because tumor reduction may improve the patients’ quality of life.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nevertheless, most studies report similar survival rates in patients who undergo PD with positive microscopic margins (R1) compared with those who received non-surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Moreover, the extension to the liver may represent systemic disease, which is incurable with surgery, in addition to being a procedure with very high rates of morbidity; thus, most surgeons agree that it presents little benefit. In spite of this, our case demonstrates that sometimes a prolonged survival is possible (current survival is 58 months after the first surgery, 38 months after resection of metachronous liver metastases). We agree that surgery cannot be the rule in these cases, but a strategy that combines chemotherapy and surgery may be successfully used in selected cases. Although we cannot talk about a cure in the context of metastatic pancreatic cancer, it should be kept in mind that an aggressive surgical approach may offer a young patient with little comorbidity the opportunity of a prolonged survival, especially if the metastatic disease stabilizes after chemotherapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorente-Herce JM, Parra-Membrives P, Díaz-Gómez D, Martínez-Baena D, Márquez-Muñoz M, Jiménez-Vega FJ. Supervivencia prolongada tras resección de metástasis hepáticas de adenocarcinoma de páncreas. Cir Esp. 2013;91:390–392.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 701 "Ancho" => 900 "Tamanyo" => 97034 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography after pancreaticoduodenectomy showing liver metastasis of pancreatic adenocarcinoma (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 727 "Ancho" => 900 "Tamanyo" => 102881 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance image taken 2 years after liver resection showing absence of metastatic disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 1 | 16 |
| 2024 October | 68 | 4 | 72 |
| 2024 September | 109 | 9 | 118 |
| 2024 August | 80 | 3 | 83 |
| 2024 July | 88 | 7 | 95 |
| 2024 June | 71 | 3 | 74 |
| 2024 May | 82 | 4 | 86 |
| 2024 April | 71 | 5 | 76 |
| 2024 March | 111 | 5 | 116 |
| 2024 February | 118 | 3 | 121 |
| 2024 January | 146 | 3 | 149 |
| 2023 December | 108 | 5 | 113 |
| 2023 November | 120 | 11 | 131 |
| 2023 October | 166 | 5 | 171 |
| 2023 September | 120 | 2 | 122 |
| 2023 August | 102 | 2 | 104 |
| 2023 July | 128 | 3 | 131 |
| 2023 June | 108 | 2 | 110 |
| 2023 May | 112 | 7 | 119 |
| 2023 April | 111 | 2 | 113 |
| 2023 March | 96 | 4 | 100 |
| 2023 February | 85 | 4 | 89 |
| 2023 January | 94 | 6 | 100 |
| 2022 December | 58 | 2 | 60 |
| 2022 November | 73 | 11 | 84 |
| 2022 October | 61 | 7 | 68 |
| 2022 September | 74 | 11 | 85 |
| 2022 August | 70 | 5 | 75 |
| 2022 July | 56 | 9 | 65 |
| 2022 June | 59 | 5 | 64 |
| 2022 May | 45 | 10 | 55 |
| 2022 April | 62 | 10 | 72 |
| 2022 March | 102 | 10 | 112 |
| 2022 February | 104 | 3 | 107 |
| 2022 January | 63 | 5 | 68 |
| 2021 December | 62 | 8 | 70 |
| 2021 November | 47 | 15 | 62 |
| 2021 October | 68 | 11 | 79 |
| 2021 September | 60 | 7 | 67 |
| 2021 August | 66 | 7 | 73 |
| 2021 July | 50 | 8 | 58 |
| 2021 June | 66 | 8 | 74 |
| 2021 May | 94 | 17 | 111 |
| 2021 April | 228 | 6 | 234 |
| 2021 March | 111 | 9 | 120 |
| 2021 February | 78 | 6 | 84 |
| 2021 January | 91 | 12 | 103 |
| 2020 December | 92 | 10 | 102 |
| 2020 November | 84 | 8 | 92 |
| 2020 October | 71 | 8 | 79 |
| 2020 September | 71 | 9 | 80 |
| 2020 August | 72 | 8 | 80 |
| 2020 July | 78 | 2 | 80 |
| 2020 June | 68 | 5 | 73 |
| 2020 May | 103 | 15 | 118 |
| 2020 April | 73 | 12 | 85 |
| 2020 March | 54 | 4 | 58 |
| 2020 February | 92 | 12 | 104 |
| 2020 January | 88 | 13 | 101 |
| 2019 December | 102 | 7 | 109 |
| 2019 November | 61 | 11 | 72 |
| 2019 October | 446 | 7 | 453 |
| 2019 September | 79 | 3 | 82 |
| 2019 August | 74 | 9 | 83 |
| 2019 July | 59 | 26 | 85 |
| 2019 June | 91 | 19 | 110 |
| 2019 May | 264 | 58 | 322 |
| 2019 April | 76 | 18 | 94 |
| 2019 March | 35 | 5 | 40 |
| 2019 February | 30 | 7 | 37 |
| 2019 January | 34 | 3 | 37 |
| 2018 December | 30 | 3 | 33 |
| 2018 November | 39 | 4 | 43 |
| 2018 October | 30 | 8 | 38 |
| 2018 September | 52 | 1 | 53 |
| 2018 August | 12 | 2 | 14 |
| 2018 July | 8 | 0 | 8 |
| 2018 June | 16 | 3 | 19 |
| 2018 May | 15 | 2 | 17 |
| 2018 April | 9 | 0 | 9 |
| 2018 March | 8 | 2 | 10 |
| 2018 February | 9 | 1 | 10 |
| 2018 January | 12 | 2 | 14 |
| 2017 December | 13 | 0 | 13 |
| 2017 November | 7 | 2 | 9 |
| 2017 October | 14 | 0 | 14 |
| 2017 September | 6 | 2 | 8 |
| 2017 August | 18 | 3 | 21 |
| 2017 July | 19 | 3 | 22 |
| 2017 June | 27 | 2 | 29 |
| 2017 May | 30 | 1 | 31 |
| 2017 April | 30 | 2 | 32 |
| 2017 March | 24 | 1 | 25 |
| 2017 February | 21 | 0 | 21 |
| 2017 January | 31 | 0 | 31 |
| 2016 December | 18 | 4 | 22 |
| 2016 November | 27 | 1 | 28 |
| 2016 October | 22 | 7 | 29 |
| 2016 September | 31 | 2 | 33 |
| 2016 August | 24 | 3 | 27 |
| 2016 July | 12 | 2 | 14 |
| 2016 June | 19 | 5 | 24 |
| 2016 May | 39 | 13 | 52 |
| 2016 April | 38 | 11 | 49 |
| 2016 March | 21 | 14 | 35 |
| 2016 February | 17 | 9 | 26 |
| 2016 January | 8 | 3 | 11 |
| 2015 December | 10 | 5 | 15 |
| 2015 November | 12 | 4 | 16 |
| 2015 October | 23 | 5 | 28 |
| 2015 September | 29 | 8 | 37 |
| 2015 August | 9 | 2 | 11 |
| 2015 July | 7 | 5 | 12 |
| 2015 June | 3 | 3 | 6 |
| 2015 May | 9 | 1 | 10 |
| 2015 April | 16 | 14 | 30 |
| 2015 March | 12 | 6 | 18 |
| 2015 February | 12 | 2 | 14 |
| 2015 January | 18 | 1 | 19 |
| 2014 December | 53 | 14 | 67 |
| 2014 November | 22 | 3 | 25 |
| 2014 October | 21 | 7 | 28 |
| 2014 September | 6 | 3 | 9 |
| 2014 August | 12 | 1 | 13 |
| 2014 July | 21 | 4 | 25 |
| 2014 June | 13 | 3 | 16 |
| 2014 May | 11 | 2 | 13 |
| 2014 April | 10 | 1 | 11 |
| 2014 March | 6 | 1 | 7 |
| 2014 February | 7 | 7 | 14 |
| 2014 January | 12 | 2 | 14 |
| 2013 December | 7 | 4 | 11 |
Show all
