Surgical treatment of liver metastasis from pancreatic cancer.

[BACKGROUND] Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related mortality, projected to become the second by 2030. Liver metastases from PDAC (LMPC) are typically deemed inoperable, with dismal prognosis and limited surgical roles. However, emerging evidence suggests that liver resection may benefit selected patients. This study evaluates overall survival (OS), disease-free survival (DFS), and prognostic factors following hepatic resection for synchronous and metachronous LMPC.

[METHODS] A retrospective, multicenter cohort study from the REMENOCOR Project included 66 patients who underwent liver resection for LMPC in Spain between 2010 and 2022. Eligible patients were ≥18 years with histologically confirmed PDAC and liver metastases. Survival outcomes, postoperative morbidity (Clavien-Dindo, CCI), and prognostic indicators were analyzed using Kaplan-Meier and univariate and multivariate methods.

[RESULTS] R0 resection was achieved in 72.7 % of the patients, and major complications occurred in 19.6 %, with 1.5 % mortality. The 5-year OS and DFS were 26.6 % and 12.7 %, respectively. LMPC were metachronic in 65.2 % of patients. Synchronous resection correlated with significantly poorer OS (5 % vs. 38 %, p < 0.05). Synchronous surgery and advanced pancreatic T-stage emerged as independent negative prognostic factors.

[CONCLUSION] Liver resection for metachronous LMPC may offer meaningful survival in selected patients, underscoring the importance of individualized surgical strategies and the need for prospective trials.