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Novel Indications for Surgical Resection of Metachronous Lung Metastases From Pancreatic Cancer After Curative Resection

Nakajima, Masao MD; Ueno, Tomio MD, PhD; Suzuki, Nobuaki MD, PhD; Matsui, Hiroto MD; Shindo, Yoshitaro MD, PhD; Sakamoto, Kazuhiko MD, PhD; Tokuhisa, Yoshihiro MD, PhD; Tokumitsu, Yukio MD, PhD; Takeda, Shigeru MD, PhD; Yoshino, Shigefumi MD, PhD; Hazama, Shoichi MD, PhD; Nagano, Hiroaki MD, PhD

Journal of Clinical Gastroenterology: May/June 2017 - Volume 51 - Issue 5 - p e34–e38
doi: 10.1097/MCG.0000000000000551
ONLINE ARTICLE: Case Report

Few reports exist regarding surgical resection of metachronous lung metastases (MLM) from pancreatic ductal adenocarcinoma (PDA) after curative resection. To elucidate the indications for surgical resection of MLM and long-term survival, we analyzed Japanese case reports of MLM from PDA. Between 1983 and 2014, 17 Japanese case reports concerning surgical resection of MLM from PDA were published. We determined long-term survival in 16 patients (considering the published data of 15 patients and 1 of our own) by using a questionnaire survey and analyzing the relationships between background factors and long-term survival. In 16 patients with long-term survival, 4 patients were still alive without recurrence. The remaining 12 patients died of disease after recurrence. The median survival after the initial lobectomy was 37 months and the 3- and 5-year survival for all patients after lobectomy was 50% and 41%, respectively. Fourteen patients had a disease-free interval after initial resection of the primary pancreatic tumor of >20 months. These patients had a longer median survival period after lobectomy (46 vs. 25.5 mo, P=0.19). Seven patients had MLM of <16 mm. These patients had a statistically longer overall survival after lobectomy (83 vs. 16 mo, P=0.04). Three of 4 patients with primary stage I tumors were still alive without recurrence. We found that the conventional criteria for surgical resection of MLM from PDA (first disease-free interval of >20 mo with no other metastatic lesions) were appropriate. In addition, it is possible that MLM of <16 mm or primary stage I tumors are novel criteria.

Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

The authors declare that they have nothing to disclose.

Address correspondence to: Hiroaki Nagano, MD, PhD, Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan (e-mail: hnagano@yamaguchi-u.ac.jp).

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