Outcomes of pancreaticoduodenectomy in patients with metastatic cancer

BACKGROUNDS/AIMS: Metastatic cancer of pancreas is rarely resectable. Pancreaticoduodenectomy carries high risks of morbidities and mortalities that it is rarely performed for metastatic cancer. In this study, the clinical features and outcomes of metastatic cancer of pancreas after pancreaticoduodenectomy were reviewed and analyzed. METHODS: We retrospectively reviewed patients who underwent pancreaticoduodectomy from January 2000 to December 2012 in Samsung Medical Center. A total of 1045 patients were enrolled in this study. Inclusion criteria were patients who had metachronous lesions with tumors histologically confirmed as metastatic cancer. However, patients with tumors directly invaded pancreas head, bile duct, and duodenum were excluded from this study. Finally, a total of 12 patients who underwent pancreaticoduodenectomy due to metastatic cancer were used in this study. Clinicopathologic features and perioperative data of these 12 patients were retrospectively reviewed. RESULTS: The 12 patients included 6 females and 6 males who had metastatic lesions at pancreas head, duodenum 2nd-3rd portion, and distal common bile duct. The mean age of patients was 62.7 years old at the time of pancreaticoduodenectomy. The interval between the time of the first operation for primary cancer and pancreaticoduodenectomy was 67.7 months. The mean survival time after pancreaticoduodectomy was 38.6 months (range, 12 to 119 months). There was no fatal complication after the surgery. CONCLUSIONS: Pancreaticoduodenectomy is becoming a safer procedure with less complication compared to the past. Patients with recurrent metastatic cancer should be considered for metastectomy if tumors are resectable. Pancreaticoduodenectomy should be considered as one main treatment for patients with recurrent metastatic cancer to offer a chance of long-term survival in selected patients.

Synchronous Colorectal Cancer

PURPOSE: Synchronous colorectal cancer is clinically significant because there is a chance to miss concurrent lesions. The aim of this study is to investigate the clinical features of synchronous colorectal cancer. METHODS: Retrospectively, the records of 4,494 colorectal cancer patients who underwent a potentially curative resection for colorectal cancer from September 1994 to December 2005 were reviewed. Synchronous colorectal cancer was defined according to the following two criteria: 1) two or more colorectal cancers had to be found simultaneously in the same patient and 2) each of the tumors had to be distinctly separated by an intact bowel wall. RESULTS: Synchronous colorectal cancer was diagnosed in 114 patients (2.5%). Synchronous colorectal cancer shows different features compared with single colorectal cancer. Synchronous colorectal cancer occurs at a older age, occurs more frequently in the colon, has a bigger size, and has more polyps. There was no difference of stage based on survival rate between synchronous and single colorectal cancer patients. The preoperative diagnosis rate of synchronous colorectal cancer was 74.6%. Eleven (9.6%) synchronous colorectal cancer patients underwent a total colectomy, and there were no significant differences in survival or complications compared with the other group. CONCLUSION: Synchronous colorectal cancer is difficult to diagnose preoperatively. Early postoperative examination for synchronous colorectal cancer is required, especially in patients who did not have a complete preoperative evaluation.