LAUSR

BACKGROUND Although distant metastasis from pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, some single center studies reported that lung metastasis has a favorable prognosis. The aim of this study is to evaluate the prognostic value of site-specific metastasis after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), with a focus on lung metastasis. METHODS Data from 117 cases of lung metastasis after pancreatectomy were collected retrospectively from 23 institutions in Japan. To compare the sites of metastasis we also collected the data of 134 patients with liver only metastasis, 67 patients with peritoneal only metastasis and 121 patients with locoregional recurrence alone. RESULTS In patients with lung only metastasis, the median time from recurrence to death (RTD) was 23.1 months, which was better in comparison to other sites of recurrence. In lung metastasis group, the patients who underwent pulmonary resection had better long-term outcomes in comparison to those who did not. (RTD: 29.2vs15.2, p<0.001). In the multivariate analysis, solitary metastasis (HR 5.03; 95% CI 1.195-21.144, p=0.022) and postoperative chemotherapy (HR 14.089; 95% CI 1.729-114.77, p=0.023) were identified as significant prognostic factors after lung resection. CONCLUSIONS Surgical resection is a favorable option for selected patients with a solitary lung metastasis and for whom adjuvant chemotherapy can be administrated.