Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival

Abstract

Objectives: This study was conducted to determine if pulmonary metastasectomy (PM) for isolated pancreatic cancer metastases is safe and effective.

Methods: This was a retrospective case-control study of patients undergoing PM at our institution from 2000 to 2009 for isolated lung metastasis after resection for pancreatic cancer. Clinical and pathologic data were compared with a matched reference group. Resected neoplasms were immunolabeled for the Dpc4 protein. Kaplan-Meier analysis compared overall survival and survival after relapse.

Results: Of 31 patients with isolated lung metastasis, 9 underwent 10 pulmonary resections. At initial pancreas resection, all patients were stage I or II. Other baseline characteristics were similar between the two groups. Median time from pancreatectomy to PM was 34 months (interquartile range 21-49). During the study, 29/31(90.6%) patients died. There were no in-hospital mortalities or complications after PM. Median cumulative survival was significantly improved in the PM group (51 vs. 23 months, p = 0.04). There was a trend toward greater 2-year survival after relapse in the PM group (40% vs. 27%, p = 0.2).

Conclusions: In patients with isolated lung metastasis from pancreatic adenocarcinoma, this is the first study to show that pulmonary resection can be performed safely with low morbidity and mortality. The improved survival in the PM group may result in part from selection bias but may also represent a benefit of the procedure.

Figure 1

Kaplan-Meier figure depicting estimates of cumulative survival, stratified by patients who underwent pulmonary metastasectomy versus those who did not. P-value determined using Cox-Mantel log rank analysis.

Figure 2

Kaplan-Meier figure depicting estimates of survival after relapse, stratified by patients who underwent pulmonary metastasectomy versus those who did not. P-value determined using Cox-Mantel log rank analysis.

Figure 3

Histology specimens with assessment of Dpc4 status. Primary pancreas specimen depicting loss of Dpc4 staining (A) and lung specimen from the same patient also depicting loss of Dpc4 staining (B). Intact Dpc4 status in a primary pancreas specimen (C) and lung specimen from the same patient, also demonstrating intact Dpc4 status (D).