Pulmonary metastasectomy is associated with survival after lung-only recurrence in pancreatic cancer.

Autor: Stuart CM; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO. Electronic address: Christina.Stuart@cuanschutz.edu., Kirsch MJ; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO., Zhuang Y; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO., Meguid CL; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO., Sugawara T; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO; Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Japan., Colborn KL; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO., Messersmith W; Department of Medicine, University of Colorado School of Medicine, Aurora, CO., Lieu C; Department of Medicine, University of Colorado School of Medicine, Aurora, CO., Gleisner AL; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO., Del Chiaro M; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO., Schulick RD; Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO., Meguid RA; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 Sep; Vol. 174 (3), pp. 654-659. Date of Electronic Publication: 2023 Jun 28.
DOI: 10.1016/j.surg.2023.05.008
Abstrakt: Background: After surgical resection of pancreatic ductal adenocarcinoma, 14% of patients have lung-only recurrence. We hypothesize that in patients with isolated lung metastases from pancreatic ductal adenocarcinoma, pulmonary metastasectomy offers a survival benefit with minimal additional morbidity after resection.
Methods: This was a single-institution, retrospective study of patients who underwent definitive resection of pancreatic ductal adenocarcinoma and later developed isolated lung metastases between 2009 and 2021. Patients were included if they carried a diagnosis of pancreatic ductal adenocarcinoma, underwent pancreatic resection with curative intent, and subsequently developed lung metastases. Patients were excluded if they developed multiple sites of recurrence.
Results: We identified 39 patients with pancreatic ductal adenocarcinoma and isolated lung metastases, 14 of whom underwent pulmonary metastasectomy. During the study period, 31 (79%) patients died. Across all patients, there was an overall survival of 45.9 months, a disease-free interval of 22.8 months, and survival after recurrence of 22.5 months. Survival after recurrence was significantly longer in patients who underwent pulmonary metastasectomy than those who did not (30.8 months vs 18.6 months, P < .01). There was no difference in overall survival between groups. However, patients who underwent pulmonary metastasectomy were significantly more likely to be alive 3 years after their diagnosis (100.0% vs 64%, P = .02) and 2 years after recurrence (79% vs 32%, P < .01) than those in who did not undergo pulmonary metastasectomy. No mortalities occurred related to pulmonary metastasectomy, and procedure-related morbidity was 7%.
Conclusion: Patients who underwent pulmonary metastasectomy for isolated pulmonary pancreatic ductal adenocarcinoma metastases had significantly longer survival after recurrence and clinically meaningful survival benefit with minimal additional morbidity after pulmonary resection.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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