Table 4.
Criteria of response to initial chemotherapy, inclusion criteria for surgery, IC regimens and outcomes of five series of patients with lmPDAC who underwent surgery after IC.
| Criteria of Response to IC | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| References | Patients | Primary Tumor | Liver Metastases | Level of CA19.9 | Total Patients with lmPDAC, N | Patients Undergoing Surgery after IC, N (%) | Type of Initial Chemotherapy, N (%) | Complications after Surgery N (%) | Median Postoperative Stay Days (Range) | OS in Patients who Underwent IC+Surgery Months (Range) | OS in Patients who Underwent IC alone Months (Range) |
| Frigerio [24] (2017) | lmPDAC who responded to systemic chemotherapy and underwent successful surgery. | Not specified | Disappearance of liver metastasis on radiological examination | Normalization or significant reduction of CA19.9 | 535 | 24 (4.5) | FOLFIRINOX N 16 (66), GEM N 5 (21), Gemcitabine+Paclitaxel N 3 (13) |
PF B N4 (16.5) PF C N1 (4) HEMORRHAGE N1 (4) SEPSIS N3 (12.5) |
13 (7–40) | 56 (36–75)°° | - |
| Crippa [25] (2016) | lmPDAC who responded to systemic chemotherapy and underwent successful surgery. | Resectable or borderline | Complete or a major radiological response of the liver metastases with a single metastasis remaining | Major biochemical response | 127 | 11 (8.5) | FOLFIRINOX N3 (27), PDXG N1 (9), PEFG N1 (9), PEXG N4 (36), GEMOX N2 (2) | PF A N2 | 8 | 39°° | 11°° |
| Kandel [27] (2018) | lmPDAC who underwent systemic chemotherapy, primary tumor resection, and metastasectomy and/or RFA | Not specified | Not specified | Not specified | Not specified | 4 (28) | Not specified | Not specified | Not specified | 23.25°° | 11.76°° |
| Tanaka [26] (2019) | lmPDAC undergoing pancreasectomy and metastasectomy after FOLFIRINOX | No tumor progression, technically resectable disease (resectable or borderline resectable, as defined by the NCCN guidelines) | A maximum of six metastatic lesions | Not specified | 57 | 30 (52.6) | All patients FOLFIRINOX | Not specified | 13 (5–56) | 25.39°° | 16.4°° |
| Byun [29] (2019) | lmPDAC who responded to systemic chemotherapy and underwent successful surgery. | Response to initial chemotherapy per RECIST criteria (Version 1.1), absence of local tumor extension to the major vessel | Single metastatic lesion or considered as resectable | Tumor markers normalized (or metabolic uptake decreased in PET) | 80 | 1 (1.25) | All patients FOLFIRINOX | None | Not specified | 23°° | 13°° |
PF: pancreatic fistula (defined according to ISGPF criteria: grade A-B-C); lmPDAC: liver metastatic pancreatic adenocarcinoma; IC: initial chemotherapy; GEM: gemcitabine; GEMOX: gemcitabine and oxaliplatin; FOLFIRINOX: oxaliplatin, irinotecan, fluorouracil and leucovorin; PEXG/PDXG: cisplatin, capecitabine, gemcitabine plus either epirubicin (PEXG) or docetaxel (PDXG); PEFG: cisplatin, epirubicin, fluorouracil and gemcitabine. Values are overall survival from diagnosis, °° overall survival from surgery.