The Incidence and Outcomes of Pancreatectomy in Patients with Metastatic Pancreatic Adenocarcinoma

  • Shaun McKenzie Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center. Duarte, CA, USA
  • Brian Mailey Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center. Duarte, CA, USA
  • Avo Artinyan Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center. Duarte, CA, USA
  • Joseph Kim Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center. Duarte, CA, USA
  • Joshua D I Ellenhorn Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center. Duarte, CA, USA
Keywords: Carcinoma, Pancreatic Ductal, Pancreatic Neoplasms, Pancreaticoduodenectomy


Context Despite current management guidelines, patients with metastatic pancreatic cancer continue to undergo pancreatic resection. Objective Our objective was to determine the incidence and outcomes of pancreatic resection in the setting of known metastatic disease. Design Using the Los Angeles County Cancer Surveillance Program, patients with pancreatic adenocarcinoma who underwent pancreatic resection with known M1 (AJCC stage IV) metastatic disease between the years 1988-2006 were assessed. Setting Large population based database query. Patients Patients with biopsy proven M1 pancreatic adenocarcinoma. Interventions Pancreatic resection, systemic chemotherapy, radiation therapy. Main outcome measure Overall survival. Results Of 8,549 patients with pancreatic adenocarcinoma from Cancer Surveillance Program, 54% (n=4,649) initially presented with M1 disease. Within this M1 cohort, 2% (n=92) of patients underwent pancreatic resection and formed our final study cohort; these patients comprised 7% of the overall number of pancreatic resections performed for pancreatic adenocarcinoma during the study period. Only 35% (n=32) of the study cohort received adjuvant chemotherapy; and 13% (n=12) received adjuvant radiotherapy. Median survival for the study cohort was 6.3 months. Surgery provided no survival benefit over chemotherapy in patients with M1 disease and was associated with an 18% 30-day mortality. Conclusion A large number of patients from Los Angeles County have undergone pancreatic resection despite the presence of known metastatic disease. Patient survival remains abysmal in this setting and these results are likely a microcosm of the surgical management of metastatic pancreatic cancer in the USA. These results highlight the necessary efforts to maintain appropriate standards of care in the management of pancreatic cancer.

Image: Survival analysis of M1 patients with pancreatic adenocarcinoma.


Download data is not yet available.


Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer Statistics 2008. CA Cancer J Clin 2008; 58:71-96. [PMID 18287387]

Nieto J, Grossbard M, Kozuch P. Metastatic pancreatic cancer 2008. Is the glass less empty? Oncologist 2008; 13:562-76. [PMID 18515741]

Neoptolemos J, Stocken D, Freiss H, Bassi C, Dunn J, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350:1200-10. [PMID 15028824]

Winter J, Cameron J, Campbell K, Arnold M, Chang D, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single institution experience. J Gastrointest Surg 2006; 10:1199-210. [PMID 17114007]

Wagner M, Redaelli C, Lietz M, Seiler C, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004; 91:586-94. [PMID 15122610]

Shaib Y, Davila J, Naumann C, El-Serag H. The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. population-based study. Am J Gastroenterol 2007; 102:1377-82. [PMID 17403071]

Takada T, Yasuda H, Amano H, Yoshida M, Uchida T. Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival? Hepatogastroenterology 1997; 44:567-73. [PMID 9164539]

Gleisner A, Assumpcao L, Cameron J, Wolfgang C, Choti M, Herman J, et al. Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 2007; 110:2484-92. [PMID 17941009]

Shrikhande S, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I, et al. Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 2006; 14:118-27. [PMID 17066229]

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™). Pancreatic Adenocarcinoma. V.I.2010. Fort Washington, PA, USA. (Accessed Oct 6, 2009).

National Cancer Institute. Pancreatic Cancer Treatment (PDQ®). Health Professional Version. Bethesda, MD, USA. (Accessed Oct 6, 2009).

Kim J, Mailey B, Senthil M, Artinyan A, Sun C, Bhatia S. Disparities in gastric cancer outcomes among Asian ethnicities in the USA. Ann Surg Oncol 2009; 16:2433-41. [PMID 19582508]

World Health Organization. ICD-O: International Classification of Diseases for Oncology, 3rd Ed. (ICD-O-3). Geneva, Switzerland: World Health Organization, 2000.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53:457-81.

Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database. J Am Coll Surg 1999; 189:1-7. [PMID 10401733]

Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15:2403-13. [PMID 9196156]

Sultana A, Smith C Cunningham D, Starling N, Neoptolemos J, Ghaneh P. Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 2007; 25:2607-15. [PMID 17577041]

Yip D, Karapetis C, Strickland A, Steer C, Goldstein D. Chemotherapy and radiotherapy for inoperable advanced pancreatic cancer. Cochrane Database Syst Rev 2006; 3:CD002093. [PMID 16855985]

Heinemann V, Boeck, S Hinke A, Labianca R, Louvet C. Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied to advanced pancreatic cancer. BMC Cancer 2008; 8:82. [PMID 18373843]

Moore M, Goldstein D, Hamm J, Figer A, Hecht J, Gallinger S, et al. Erlotinib plus gemcitabine compared to gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2007; 25:1960-6. [PMID 17452677]

Philip PA, Benedetti J, Fenoglio-Preiser C, Zalupski M, Lenz H, O'Reilly E, et al. Phase III study of gemcitabine plus cetuximab versus gemcitabine in patients with locally advanced or metastatic pancreatic adenocarcinoma SWOG S0205 study. J Clin Oncol 2007; 25(18 Suppl):LBA4509.

Kullmann F, Hollerbach S, Dollinger M, Harder J, Fuchs M, Messmann H, et al. Cetuximab plus gemcitabine/oxaliplatin (gemocet) in first-line metastatic pancreatic cancer: a multicentre phase II study. Br J Cancer 2009; 100:1032-6. [PMID 19293797]

Kindler HL, Niedzwiecki D, Hollis D, Oraefo E, Schrag D, Hurwitz H, et al. A double-blind, placebo-controlled, randomized phase III trial of gemcitabine plus bevacizumab versus gemcitabine plus placebo in patients with advanced pancreatic cancer: a preliminary analysis of Cancer and Leukemia Group B (CALGB) 80303. J Clin Oncol 2007; 25(18 Suppl):4508.

Saif M. New developments in the treatment of pancreatic cancer. Highlights from the '44th ASCO Annual Meeting'. Chicago, IL, USA. May 30 - June 3, 2008. JOP. J Pancreas (Online) 2008; 9:391-7. [PMID 18648128]

Ko AH, Dito E, Schillinger B, Venook AP, Xu Z, Bergsland EK, et al. A phase II study evaluating bevacizumab in combination with fixed-dose rate gemcitabine and low-dose cisplatin for metastatic pancreatic cancer: is an anti-VEGF strategy still applicable? Invest New Drugs 2008; 26:463-71. [PMID 18379729]

Van Cutsem E, Vervenne W, Bennouna J Humblet Y, Gill S, Van Laethem J, et al. Phase III trial of bevacizumab in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. J Clin Oncol 2009; 27:2231-7. [PMID 19307500]

Schelldorfer T, Ware A, Sarr M, Smyrk T, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 2008; 247:456-62. [PMID 18376190]

Riall T, Cameron J, Lillemoe K, Winter J, Campbell, Hruban R, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow up. Surgery 2006; 140:764-72. [PMID 17084719]

Ferrone C, Brennan M, Gohen M, Coit D, Fong Y, Chung S, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 2008; 12:701-6. [PMID 18027062]

Balcom J IV, Rattner D, Warshaw A, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, decreasing length of hospitalization. Arch Surg 2001; 136:391-8. [PMID 11296108]

Lillemoe K, Cameron J, Yeo C, Sohn T, Nakeeb A, Sauter P, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg 1996; 223:718-28. [PMID 8645045]

Survival analysis of M1 patients with pancreatic adenocarcinoma
How to Cite
McKenzieS., MaileyB., ArtinyanA., KimJ., & EllenhornJ. (2010). The Incidence and Outcomes of Pancreatectomy in Patients with Metastatic Pancreatic Adenocarcinoma. JOP. Journal of the Pancreas, 11(4), 341-347.