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Surgery or Locoregional Approaches for Hepatic Oligometastatic Pancreatic Cancer: Myth, Hope, or Reality?

1
Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2
Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
3
Department of Oncology, University Hospital of Modena and Reggio Emilia, 41125 Modena, Italy
4
Department of Medicine, Royal Marsden Hospital, London and Surrey, Sutton SM2 5PT, UK
5
Surgical Oncology Unit, Surgery Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
6
Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
7
Oncology Unit, Oncology Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2019, 11(8), 1095; https://doi.org/10.3390/cancers11081095
Received: 10 July 2019 / Revised: 27 July 2019 / Accepted: 28 July 2019 / Published: 1 August 2019
(This article belongs to the Special Issue Advances in Pancreatic Cancer Research)
Despite extensive research, pancreatic ductal adenocarcinoma (PDAC) remains a difficult-to-treat cancer associated with poor survival. Due to the known aggressive disease biology, palliative chemotherapy is the only routinely recommended treatment in the metastatic setting in patients with adequate performance status. However, in a subset of patients with oligometastatic disease, multimodality treatment with surgery and/or locoregional approaches may provide long-term disease control and prolong survival. In fact, in highly selected cases, median overall survival has been reported to extend to 56 months in patients treated with surgery. In particular, liver and extraregional nodal resections may provide long-term tumor control with acceptable morbidity. Current guidelines do not recommend surgery for patients with metastatic PDAC and, in the case of PDAC with oligometastases, there are no published randomized controlled trials regarding locoregional or surgical approaches. Here we review the literature on surgical and locoregional approaches including radiofrequency ablation, irreversible electroporation, and stereotactic body radiation, and focus on patients with hepatic oligometastatic pancreatic cancer. We provide a summary regarding survival outcomes, morbidity and mortality and discuss selection criteria that may be useful to predict the best outcomes for such strategies. View Full-Text
Keywords: pancreatic cancer; liver metastases; oligometastatic disease; pancreatic surgery; liver resection; chemotherapy; liver metastasectomy; radiofrequency ablation; irreversible electroporation; stereotactic body radiation therapy pancreatic cancer; liver metastases; oligometastatic disease; pancreatic surgery; liver resection; chemotherapy; liver metastasectomy; radiofrequency ablation; irreversible electroporation; stereotactic body radiation therapy
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Ghidini, M.; Petrillo, A.; Salati, M.; Khakoo, S.; Varricchio, A.; Tomasello, G.; Grossi, F.; Petrelli, F. Surgery or Locoregional Approaches for Hepatic Oligometastatic Pancreatic Cancer: Myth, Hope, or Reality? Cancers 2019, 11, 1095.

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