Comparative Analysis Of Efficacy In Combined Liver And Pancreas Resection And Systemic Chemotherapy For Resectable Pancreatic Cancer With Liver Metastasis

Objective: Pancreatic cancer with liver metastasis(PCLM)has occult onset,rapid progression and poor prognosis,systemic chemotherapy is the main treatment at present.In recent years,more and more medical centers begin to carry out surgical treatment for PCLM.However,as one of the possible treatment options to achieve radical cure,whether surgery can bring more survival benefits to patients than chemotherapy remains controversial.The purpose of this study is to compare the efficacy of combined liver and pancreas resection and systemic chemotherapy in patients with resectable PCLM.Methods: Patients admitted to Shengjing Hospital of China Medical University from January 1,2013 to May 31,2020 and diagnosed with PCLM were retrospectively analyzed.Patients with resectable PCLM were selected and then divided into Surgery group and Chemotherapy group using propensity score matching(PSM).The overall survival time of the two groups was compared,the priority of the two treatment methods was evaluated and factors influencing survival time were analyzed.Results: There were 56 patients with resectable PCLM after case screening,including 33 patients in the Surgery group,23 patients in the Chemotherapy group,and 15 patients in each group after PSM matching.There were no significant differences in gender,age,BMI,biochemical indexes,levels of CEA and CA19-9,location and size of pancreatic tumor,number and size of liver metastases between the two groups.No matter before and after PSM,the median overall survival(m OS)of patients in Surgery group was significantly shorter than that of patients in Chemotherapy group(before PSM,m OS of patients in Surgery group and Chemotherapy group: 6.6 months vs 10.4 months,P = 0.034;after PSM,m OS of patients in Surgery group and Chemotherapy group: 6.4 months vs 10.5 months,P = 0.038).Postoperative complications in Surgery group mainly included postoperative bleeding,pancreatic fistula,infection,delayed gastric emptying and so on.Multivariate analysis of 33 patients in operation group showed that poorly differentiated tumor(HR =4.945;P = 0.001)and no postoperative chemotherapy(HR = 3.670;P = 0.007)were independent risk factors for poor prognosis.Conclusion: Combined liver and pancreas resection failed to prolong the overall survival of patients with resectable PCLM when compared with chemotherapy.Postoperative chemotherapy is of great significance to prolong the survival time.