Oligometastatic pancreatic cancer to the liver in the era of neoadjuvant chemotherapy: Which role for conversion surgery? A systematic review and meta-analysis

Ottavia De Simoni, Marco Scarpa, Marco Tonello, Pierluigi Pilati, Francesca Tolin, Ylenia Spolverato, Mario Gruppo

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: the improved survival rates achieved using new polychemotherapy regimens in patients with metastatic pancreatic cancer (mPDAC) have suggested a potential role for surgery following a favorable response to initial chemotherapy (IC). The purpose of this systematic review is to summarize the available evidence on the role of surgery following IC in mPDAC, focusing on oligometastatic disease to the liver (lmPDAC). Methods: studies reporting on patients with lmPDAC undergoing surgery after IC were included. The main outcome was overall survival (OS). Results: six observational retrospective studies were included in the qualitative analysis. Data were retrieved on 2087 patients. The most common IC regimen in patients undergoing surgery was FOLFIRINOX (N 84, 73%). Only three studies reported survival comparison among patients treated with IC+surgery vs. IC alone. Median OS varied from 23 to 56 months after conversion surgery vs. 11 to 16.4 months after IC alone. Conclusions: despite wide heterogeneity of chemotherapy regimens, different downstaging criteria and potential selection biases, patients with oligometastatic lmPDAC undergoing surgery after IC have significantly higher survival rates compared to patients treated with IC alone. Future trials are needed for definition of univocal criteria of downstaging, oligometastatic definition and indications for surgery.

Original languageEnglish
Article number3402
Pages (from-to)1-14
Number of pages14
JournalCancers
Volume12
Issue number11
DOIs
Publication statusPublished - Nov 17 2020

Keywords

  • Conversion surgery
  • Initial chemotherapy
  • Liver metastases
  • Oligometastatic disease
  • Pancreatic cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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