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Stuart CM, Kirsch MJ, Zhuang Y, Meguid CL, Sugawara T, Colborn KL, Messersmith W, Lieu C, Gleisner AL, Del Chiaro M, Schulick RD, Meguid RA. Pulmonary metastasectomy is associated with survival after lung-only recurrence in pancreatic cancer. Surgery 2023; 174:654-659. [PMID: 37391327 DOI: 10.1016/j.surg.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/24/2023] [Accepted: 05/24/2023] [Indexed: 07/02/2023]
Abstract
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.
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Affiliation(s)
- Christina M Stuart
- 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.
| | - Michael J Kirsch
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Yaxu Zhuang
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Cheryl L Meguid
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Toshitaka Sugawara
- 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
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Wells Messersmith
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Christopher Lieu
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Ana L Gleisner
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Marco Del Chiaro
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Richard D Schulick
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Robert A Meguid
- 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
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