Oncological outcomes and prognostic factors of pulmonary metastasectomy in pancreatic cancer

The number of long-term survivors after pancreatic cancer is increasing due to recent advances in diagnosis and multidisciplinary treatments. However, the effectiveness of pulmonary metastasectomy remains uninvestigated. This study aims to evaluate the oncological outcomes of pulmonary metastasectomy in pancreatic cancer and to identify potential prognostic factors affecting survival. Patients undergone pulmonary metastasectomy, with previous radical surgery on pancreatic cancer and no evidence of disease in other organs, were selected. Therefore, clinical data of 56 patients from 7 high-volume centers were retrospectively analyzed. Long-term oncological outcomes and prognostic factors were evaluated. Five- and 10-year OS from pancreatectomy were 76% and 42%, respectively. Multivariable analysis confirmed as negative prognostic factors: male sex (HR = 25.7, 95%CI 3.5–190.2, p = 0.001), major lung metastasis diameter > 1.3 cm (HR = 50.8, 95%CI 3.7–692.2, p = 0.003) and synchronous metastases with primary cancer (HR = 61.2, 95%CI 3.1–1203.2, p = 0.007). The 5-year DFS from pancreatectomy and first lung metastasis was 13%, with a median of 32 months. The only prognostic factor affecting DFS was pN2 pancreatic disease (p = 0.008) at multivariable analysis. The 1-year DFI between first and second lung metastasis was 9%, with a median of 11 months. The 5-year OS from the first pulmonary metastasectomy was 47%. The main prognostic factors at univariable analysis were pT (p < 0.001), RT/CT neoadjuvant or adjuvant therapy after pancreatectomy (p = 0.01), major lung metastasis diameter > 1.3 cm (p = 0.04) and reiterative lung metastasectomy for pulmonary recurrence (p = 0.04). No factor was confirmed in the multivariable analysis. Pulmonary metastasectomy after radical surgery for pancreatic cancer seems to be a valuable treatment in well-selected patients. Reiterative pulmonary surgery may also represent a potential therapeutic option in carefully selected cases.