Published online Aug 15, 2018. doi: 10.4251/wjgo.v10.i8.211
Peer-review started: April 16, 2018
First decision: May 9, 2018
Revised: May 14, 2018
Accepted: June 27, 2018
Article in press: June 28, 2018
Published online: August 15, 2018
To analyse the safety and efficacy of curative intent surgery in biliary and pancreatic cancer.
An extensive literature review was performed using MEDLINE, Google Scholar and EMBASE to identify articles regarding hepato-pancreatoduodenectomy or resection of liver metastasis in patients with pancreatic, biliary tract, periampullary and gallbladder cancers.
A total of 19 studies were identified and reviewed. Major hepatectomy was undertaken in 391 patients. The median overall survival for pancreatic cancer ranged from 5-36 mo and for biliary tract/gallbladder cancer, it was 8-38 mo. The 30 d mortality rate was only 1%-9%. Overall Survival was significantly better for patients, who had good response to neoadjuvant chemotherapy, underwent metachronous liver resection and who had intestinal type tumours.
Resection of liver metastases in pancreatic and biliary cancers may provide survival benefit without compromising safety and quality of life in a very select group of patients. These data may be utilised to formulate selection criteria that may allow future investigation of resection in the era of more effective systemic therapy.
Core tip: Hepatic resection may be feasible for highly selected pancreatic and biliary tract cancer patients with a propensity towards improved outcomes and provide a chance for long term survival. The longer disease free interval between primary tumour and the liver metastases, response to the neoadjuvant treatment and other prognostic markers may also facilitate better selection of patients with more favourable tumour biology and prognosticate individual patient.