Surgical and local treatment of hepatic metastasis in pancreatic ductal adenocarcinoma: recent advances and future prospects

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with increasing incidence and mortality. More than half of PDAC patients develop metastases, with the liver being the most common site. Patients with pancreatic ductal adenocarcinoma with liver metastases (PCLM) have a very limited scope for surgery due to aggressive tumor behavior and poor prognosis. However, with the improvements in preoperative systemic therapy and perioperative outcomes, an increasing number of patients are being considered for surgical management. However, the best choice of surgical treatment and criteria for selecting suitable PCLM patients who may benefit from surgical treatment remains controversial. Palliative local treatments, such as ablation, locoregional chemotherapy, and brachytherapy, which are less invasive and have fewer contraindications and complications, are the preferred alternatives to surgery. The present study reviews the advances in the management of PCLM, with focus on resection and local therapies.

Keywords: hepatectomy; liver metastases; local therapy; pancreatic ductal adenocarcinoma; surgery.

Figure 1.

Flowchart of the PCLM treatment. EHMD, extra-hepatic metastatic disease; LM, liver metastases; PCLM, pancreatic ductal adenocarcinoma with liver metastases; PDAC, pancreatic ductal adenocarcinoma; TACE, transarterial chemoembolization; TAE, transarterial embolization.