SURGICAL MANAGEMENT OF METASTATIC PANCREATIC DUCTAL ADENOCARCINOMA
David Hyman*, Tariq Almerey, Isaac Hammons, Amer Mujkanovic, trevor betros, John Stauffer
Mayo Foundation for Medical Education and Research, Rochester, MN
Objective
Pancreatic Ductal Adenocarcinoma is one of the most aggressive cancers that even today carries a poor prognosis. Unfortunately, many patients initially present with metastatic disease. Evidence of metastatic disease presents a relative contraindication to surgical intervention. Recently, developments in therapies have significantly improved survival. Current literature shows that with multimodal therapies, a diagnosis of metastatic PDAC carries an average life expectancy of 11-16 months. With advancements in medical treatment, the potential role for conversion surgery is unclear.
Methods
This is a retrospective review of patients at a single high-volume center who received pancreatic resections for PDAC between 1/1/2010-12/31/2020. Patients who underwent surgical intervention following neoadjuvant therapy for known metastatic disease were included in this review. Patient survival and status at follow-up was recorded.
Results
370 patients received pancreatic resections for PDAC in this review. Of these, 12 subjects presented with metastatic disease at the time of initial diagnosis. 4/12 subjects are still living 10, 11, 20, and 24 months after surgery, respectively, with no evidence of recurrence on follow-up. 8/12 subjects are deceased with an average survival of 17 months. Of these subjects, 4 survived greater than 20 months with the longest survival 34 months.
Conclusion
PDAC is an aggressive disease that carries a poor prognosis. Unfortunately, many patients present with metastatic disease on initial diagnosis. As new medical treatments show improved outcomes, there may be a role for conversion surgery with a goal for disease free survival. Our results show a potential survival benefit in select patients undergoing surgery as part of a multimodal treatment approach for metastatic PDAC.
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