Advertisement

Initial pulmonary metastasis after pancreatectomy for pancreatic ductal adenocarcinoma

  • Tetsunosuke ShimizuEmail author
  • Kohei Taniguchi
  • Mitsuhiro Asakuma
  • Koji Komeda
  • Yoshihiro Inoue
  • Sang-Woong Lee
  • Fumitoshi Hirokawa
  • Kazuhisa Uchiyama
Short Communication
  • 20 Downloads

Abstract

Patients who undergo pancreatectomy for pancreatic ductal adenocarcinoma (PDA) develop relatively early recurrence, but pulmonary metastasis from PDA is rare. Between January 2008 and December 2016, a total of 120 consecutive patients underwent pancreatectomy for primary PDA at Osaka Medical College Hospital. Among these, 13 patients developed pulmonary metastasis and 6 patients underwent pulmonary metastasectomy. Among these patients, the median disease-free survival following initial pancreatic surgery was 26.1 months, and the median overall survival (OS) interval was 39 months. On the other hand, seven patients did not undergo pulmonary resection. The median OS interval of these patients was 33 months. The 1-, 3-, and 5-year OS rates were 100%, 80%, and 60%, respectively, for patients who underwent pulmonary metastasectomy and 100.0%, 42.8%, and 0%, respectively, for those who did not undergo the procedure. Our experience has shown that surgical resection may lengthen the survival time of patients who tolerate surgery.

Keywords

Pancreatic ductal adenocarcinoma Pulmonary metastasis Metastasectomy 

Abbreviations

BSC

Best supportive care

CA

Carbohydrate antigen

CEA

Carcinoembryonic antigen

CT

Computed tomography

DFS

Disease-free survival

DP

Distal pancreatectomy

DUPAN-2

Pancreatic cancer-associated antigen-2

FDG-PET

Fluorodeoxyglucose-positron emission tomography

GEM

Gemcitabine

OS

Overall survival

PD

Pancreaticoduodenectomy

PDA

Pancreatic ductal adenocarcinoma

S-1

Tegafur/gimeracil/oteracil

SPan-1

s-Pancreas-1 antigen

TP

Total pancreatectomies

UICC

Unio Internationalis Contra Cancrum

Notes

Acknowledgements

We thank all staff of Osaka Medical College for the management of patients. We would also like to thank Editage (www.editage.com) for editing the English language of this manuscript.

Author contributions

Conception and design of the study: TS and KT. Acquisition of data: TS, FH, and MA. Analysis and interpretation of the data: TS, KK, YI, SWL, and KT. Writing, review, and/or revision of the manuscript: TS, KT, and KU. Study supervision: KU. All authors have read and approved the manuscript.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

References

  1. 1.
    Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.CrossRefGoogle Scholar
  2. 2.
    Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.CrossRefGoogle Scholar
  3. 3.
    Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.CrossRefGoogle Scholar
  4. 4.
    Arnaoutakis GJ, Rangachari D, Laheru DA, Iacobuzio-Donahue CA, Hruban RH, Herman JM, et al. Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival. J Gastrointest Surg. 2011;15:1611–7.CrossRefGoogle Scholar
  5. 5.
    Thomas RM, Truty MJ, Nogueras-Gonzalez GM, Fleming JB, Vauthey JN, Pisters PW, et al. Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg. 2012;16:1696–704.CrossRefGoogle Scholar
  6. 6.
    Yasukawa M, Kawaguchi T, Kawai N, Tojo T, Taniguchi S. Surgical treatment for pulmonary metastasis of pancreatic ductal adenocarcinoma: study of 12 cases. Anticancer Res. 2017;37:5573–6.PubMedGoogle Scholar
  7. 7.
    Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35:600–4.CrossRefGoogle Scholar
  8. 8.
    Nakajima M, Ueno T, Suzuki N, Matsui H, Shindo Y, Sakamoto K, et al. Novel indications for surgical resection of metachronous lung metastases from pancreatic cancer after curative resection. J Clin Gastroenterol. 2017;51:e34–8.CrossRefGoogle Scholar
  9. 9.
    Fokas E, Engenhart-Cabillic R, Daniilidis K, Rose F, An HX. Metastasis: the seed and soil theory gains identity. Cancer Metastasis Rev. 2007;26:705–15.CrossRefGoogle Scholar
  10. 10.
    Yamashita K, Miyamoto A, Hama N, Asaoka T, Maeda S, Omiya H, et al. Survival impact of pulmonary metastasis as recurrence of pancreatic ductal adenocarcinoma. Dig Surg. 2015;32:464–71.CrossRefGoogle Scholar
  11. 11.
    Sahin IH, Elias H, Chou JF, Capanu M, O’Reilly EM. Pancreatic adenocarcinoma: insights into patterns of recurrence and disease behavior. BMC Cancer. 2018;18:769.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Tetsunosuke Shimizu
    • 1
    Email author
  • Kohei Taniguchi
    • 1
    • 2
  • Mitsuhiro Asakuma
    • 1
  • Koji Komeda
    • 1
  • Yoshihiro Inoue
    • 1
  • Sang-Woong Lee
    • 1
  • Fumitoshi Hirokawa
    • 1
  • Kazuhisa Uchiyama
    • 1
  1. 1.Department of General and Gastroenterological SurgeryOsaka Medical CollegeTakatsukiJapan
  2. 2.Translational Research ProgramOsaka Medical CollegeTakatsukiJapan

Personalised recommendations