E300: Surgical resection may improve survival in oligometastatic pancreatic cancer following systemic therapy

ePoster Abstract Author(s)

Asmita Chopra, MD (she/her/hers)

Research Resident
University of Pittsburgh Medical Center
Holland, Pennsylvania, United States

Submitter(s)

Asmita Chopra, MD (she/her/hers)

Research Resident
University of Pittsburgh Medical Center
Holland, Pennsylvania, United States

Author(s)

Asmita Chopra, MD (she/her/hers)

Research Resident
University of Pittsburgh Medical Center
Holland, Pennsylvania, United States
Julia Purchla, MD (she/her/hers)

Research Resident
Department of General Surgery, John Hopkins University School of Medicine
Baltimore, Maryland, United States
MZ

Mazen Zenati, MD

Faculty
University of Pittsburgh, United States
SA

Samer AlMasri, MD

Assistant Professor of Surgery
University of Pittsburgh Medical Center, United States
YP

Yasheel Pandya, B.S

Research Associate
Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Johns Hopkins University School of Medicine, United States
RE

Rudy El Asmar, MD PhD

Research Fellow
University of Pittsburgh Medical Center, United States
NT

Nikhil Tirukkovalur, MD

Research Fellow
University of Pittsburgh Medical Center, United States
RB

Richard A. Burkhart, MD

Associate Professor
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Johns Hopkins Hospital, United States
AS

Aatur Singhi, MD, PhD

Associate Professor of Anatomic Pathology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Kelly J. Lafaro, MD, MPH (she/her/hers)

Assistant Professor
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Johns Hopkins Hospital
Baltimore, Maryland, United States
KL

Kenneth Lee, MD

Professor of Surgery
University of Pittsburgh Medical Center, United States
CS

Christopher R. Shubert, MD, MHA

Assistant Professor
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Johns Hopkins Hospital, United States
AP

Alessandro Paniccia, MD

Assistant Professor of Surgery
Department of Surgery, University of Pittsburgh Medical Center, United States
Jin He, MD, PhD

Associate Professor
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Johns Hopkins Hospital
Baltimore, Maryland, United States
Amer H. Zureikat, MD

Professor and Chief
Division of Surgical Oncology, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
William R. Burns, MD

Assistant Professor
Johns Hopkins Department of Surgery
Baltimore, Maryland, United States

Introduction: Patients with metastatic pancreatic cancer (mPC) have a median survival less than 12 months with only 3% alive at five years. Individuals with oligometastasis (‘oligo-mPC’) may be considered for curative-intent surgery following chemotherapy. We examine outcomes of patients with oligo-mPC to the liver who underwent curative-intent surgical resection.

Methods: A bi-institutional, retrospective analysis of patients with mPC who underwent surgery between 2008-2022 was performed. Those with synchronous oligo-mPC to the liver (1-3 lesions) treated with chemotherapy followed by surgical resection were included. We analyzed patient characteristics, pathological features and oncological outcomes. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Kaplan Meier (KM) survival estimates and Cox proportional hazard ratios were analyzed.

Results: Forty-six patients with oligo-mPC to the liver were identified. Median age was 62.5 (IQR: 54-68) years and 25 (54%) were female. All received systemic chemotherapy: gemcitabine-based (7; 15.2%), fluoropyrimidine-based (32; 69.6%), or regimens including both (7; 15.2%); median duration was 7.0 (IQR: 5.6-11.0) months. CA19-9 reduction by >50% was seen in 19/23 (82.6%) patients. Pancreatic resections were pancreatoduodenectomy in 29 (63%) and distal pancreatectomy in 17 (37%) patients. The median number of liver lesions at diagnosis was 2 (IQR: 1-2), warranting major liver resection (3 or more segments) in 11 (23.9%), minor liver resection in 30 (65%) and radiofrequency ablation in 1 (2%) patients. Twelve (26.1%) patients had major complications with 1 (2.2%) 30-day mortality and 3 (6.5%) 90-day mortalities. Tumor analysis noted SMAD4 alteration (mutation or loss of expression) in 9/24 (37.5%) and TP53 mutations in 13/20 (65%). With a median follow up of 20.5 months, the median OS (from diagnosis) was 22.2 (95%CI: 18.6-31.1) months and median RFS (from surgery) was 6.4 (95%CI: 4.3-8.3) months (Figure). Predicted rates of 3-year OS and at 5-year OS were 35.9% and 11.2%, respectively. Cox regression analysis identified wild-type TP53, female gender, well-differentiated tumor, negative resection margin and lack of lymphovascular invasion to be associated with prolonged OS (P< 0.05).

Conclusions: Surgical resection is safe and feasible in patients with oligo-mPC to the liver. It may improve survival in a subset of patients who respond to systemic chemotherapy.

Learning Objectives:

Upon completion, participants will be able to understand the feasibility of surgical resection in patients with oligometastatic pancreatic cancer
Upon completion, participants will be able to discuss the possibility of prolonged survival in a small cohort of patients with metastatic pancreatic cancer, who have favorable cancer biology
Upon completion, participants will be able to justify future prospective studies to identify predictors of curative resection and prolonged survival in patients with oligometastatic pancreatic cancer