Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2018; 10(8): 211-220
Published online Aug 15, 2018. doi: 10.4251/wjgo.v10.i8.211
Pancreatic, periampullary and biliary cancer with liver metastases: Should we consider resection in selected cases?
Rachael Chang Lee, Harsh Kanhere, Markus Trochsler, Vy Broadbridge, Guy Maddern, Timothy J Price
Rachael Chang Lee, Vy Broadbridge, Timothy J Price, Department of Medical Oncology, the Queen Elizabeth Hospital, Adelaide 5011, Australia
Harsh Kanhere, Markus Trochsler, Guy Maddern, Department of Surgery, the Queen Elizabeth Hospital, Adelaide 5011, Australia
Harsh Kanhere, Markus Trochsler, Guy Maddern, Timothy J Price, School of Medicine, University of Adelaide, Adelaide 5000, Australia
Author contributions: All authors made substantial contributions to the conception of the article, analysis and interpretation of data, revision of the article critically for important intellectual content and have given final approval of the version to be submitted and any revised version; all authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content.
Conflict-of-interest statement: All authors have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Timothy J Price, FRACP, MBBS, MD, Professor, Department of Medical Oncology, the Queen Elizabeth Hospital, 28 Woodville Road, Adelaide 5011, Australia.
Telephone: +61-8-82228429
Received: April 15, 2018
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.

Research frontiers

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.

Research Innovations

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.

Research perspectives

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.