Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3677
Peer-review started: June 17, 2018
First decision: July 6, 2018
Revised: July 11, 2018
Accepted: July 22, 2018
Article in press: July 22, 2018
Published online: September 7, 2018
Pancreatic cancer remains a lethal disease and is associated with poor prognosis, particularly for patients with distant metastasis at diagnosis. Recently, Oweira reported a retrospective study that included 13233 metastatic pancreatic cancer patients from the Surveillance, Epidemiology and End Results database. They demonstrated that pancreatic cancer patients with isolated liver metastases had worse outcomes than patients with isolated lung metastases or distant nodal metastases. At present, the standard treatment for metastatic pancreatic cancer is chemotherapy. However, improvement in the safety of pancreatic surgery has led to the consideration of more aggressive surgical approaches. Schneitler reported two cases of hepatic metastatic pancreatic cancer in which negative margin (R0) resection and long survival were achieved after effective preoperative chemotherapy. In general, these two studies indicate that although pancreatic cancer patients with liver metastasis have a poor prognosis, surgical approaches may prolong survival for a few of these patients. A strategy to select hepatic metastatic pancreatic cancer patients who may benefit from surgical intervention is urgently needed.
Core tip: Pancreatic cancer patients with liver metastasis have worse prognoses than pancreatic cancer patients with metastasis at other sites. Improvement in the safety of pancreatic surgery has led to the consideration of more aggressive approaches. There is increasing agreement that synchronous resection of pancreatic cancer and liver metastases may selectively benefit some patients. A prospective multicenter, randomized, controlled phase three trial has been launched by the Chinese Study Group for Pancreatic Cancer with a goal of establishing such a selection strategy.