P29: Hepatic resection for metastatic pancreatic ductal adenocarcinoma – a prospective single institution pilot study

Thursday, March 23, 2023

12:41 PM – 12:46 PM

Location: SSO HUB Pan-Tumor Zone: CRS, HPB, Pan-Tumor & Upper GI

Poster Presenter(s)

Robin Schmitz, MD (he/him/his)

General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.

Author(s)

Robin Schmitz, MD (he/him/his)

General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.
Austin M. Eckhoff, MD

General Surgery Resident
Duke University
Durham, North Carolina, United States

Disclosure information not submitted.
Michael E. Lidsky, MD

Assistant Professor of Surgery
Duke University
Durham, North Carolina, United States

Disclosure information not submitted.
Dan Blazer, III, MD

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose
JA

James Abbruzzese, MD

Professor of Medicine
Duke University Medical Center, United States

Disclosure information not submitted.
NM

Niharika Mettu, MD, PhD

Assistant Professor of Medicine
Duke University Medical Center, United States

Disclosure information not submitted.
Peter Allen, MD

chief, surgical oncology
Duke University Medical Center
Durham, NC, United States

Disclosure information not submitted.
Sabino Zani, Jr., MD

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.

Disclosure(s):

Dan Blazer, MD, III: No financial relationships to disclose

Introduction: Surgical resection for metastatic pancreatic ductal adenocarcinoma (mPDAC) is generally contraindicated. Retrospective data, however, have demonstrated the safety and feasibility of surgical resection of oligometastatic disease, and improved survival in highly selected patients. The purpose of this pilot study is to prospectively determine whether concurrent resection of a primary pancreatic tumor and low-volume liver metastases is safe and feasible in mPDAC patients. We will also explore the clinical benefit of such an approach.

Methods: A single center interventional pilot study was conducted at our institution (NCT02892305). Patients with biopsy proven pancreatic adenocarcinoma and low-volume liver metastases (< /= 3 lesions) met inclusion criteria. All subjects were deemed surgical candidates by a hepatobiliary multidisciplinary committee. Disease control on neoadjuvant chemotherapy for at least 6 months was required prior to surgical exploration. Primary outcomes were 90-day mortality, overall survival (OS), and disease-free survival (DFS).

Results: Between 2018-2022, a total of 19 patients were enrolled of which 11 underwent successful surgical resection of the primary tumor and liver metastases. Eight patients had either progression of disease which precluded surgical exploration, peritoneal carcinomatosis upon surgical exploration, or elected not to pursue operative intervention. The median age of all resected patients was 66 years (range: 46-75 years). Median Charlson-Deyo comorbidity index was 8 (range: 7-12). The median length of neoadjuvant chemotherapy was 14 months (range: 7-50 months). We observed no 90-day mortality. After a median follow-up of 25 months, 55% of resected patients were alive, and the median OS was 33 months. The median DFS was 10 months. At the time of analysis, 27% of patients remain disease-free more than 16 months after surgery.

Conclusions: This prospective study demonstrates the safety and feasibility of concurrent surgical resection of primary tumor and liver metastases in selected patients with oligometastatic pancreatic adenocarcinoma. Prolonged DFS and OS can be achieved in a subset of such patients. Patient selection remains the most challenging task to achieve optimal outcomes and should be the focus of future studies.

Learning Objectives:

Upon completion, participant will be able to discuss the role of surgery in patients with metastatic pancreatic adenocarcinoma.
Upon completion, participant will be able to summarize long-term outcomes of patients undergoing surgery for metastatic pancreatic adenocarcinoma.
Upon completion, participant will be able to define criteria that qualify patients with metastatic pancreatic adenocarcinoma for surgical resection.