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
Hepatic metastasectomy is well established for colorectal and neuroendocrine cancer with survival benefit. The overall prognosis for advanced pancreas and biliary tract cancers remains dismal. The resection of the primary tumour and synchronous liver metastases is not recommended under current national and international guidelines for the treatment of stage 4 pancreatobiliary cancer and survival data at this time for hepatic resection under such circumstances is mixed.
The studies on the surgical management of pancreatobiliary liver metastasis are all retrospective studies involving a small number of patients. There are inconsistent results with regards to benefit of liver metastasectomy on overall survival. Hence why we conducted extensive literature review to analyse and consolidate findings from all the studies to evaluate the safety and feasibility of liver metastasectomy in setting of stage 4 pancreatic and biliary tract cancers.
This paper showed that 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. Patients with metachronous liver metastases and with good response to neoadjuvant chemotherapy derived the most benefit. However most studies included in our review were conducted long time back and did not include chemotherapy as part of neoadjuvant strategy or used biomarkers to select patients. Evolution of new neoadjuvant systemic treatment such as FOLFIRINOX and immunotherapy may have significant potential to downstage cancers to potentially resectable state. This coupled with increased safety of liver resections and discovery of potential biomarkers can aid in better population selection for resection of metastatic disease under such circumstances, with hope to improve the survival outcome.
Our review highlights the need for multi-institutional prospective trials to fully delineate the potential therapeutic utility of liver metastasectomy for hepatobiliary tract tumours in era of modern systemic treatment and for further validation of prognostic markers used for patient selection. Comprehensive genomic profiling and use of ctDNA should also be considered for improved patient stratification and treatment selection.