Survival after pulmonary metastasectomy for pancreatobiliary carcinomas: insights from a nationwide multicenter database

PURPOSE: Pancreatic carcinoma (PC) and biliary tract carcinoma (BTC) may metastasize to the lungs, and surgical resection of these metastases should be considered in selected patients with controlled primary disease. This study evaluated the survival outcomes and prognostic factors in patients who underwent pulmonary metastasectomy for pancreatobiliary carcinoma. METHODS: Seventy-eight patients who underwent lung metastasectomy between 1993 and 2019 were included in the Metastatic Lung Tumor Study Group of the Japan database. The clinicopathological characteristics including overall survival (OS), pulmonary metastasis-free survival (PmFS), and disease-free interval (DFI) from primary surgery to lung metastasectomy were analyzed. RESULTS: We included 41 men and 37 women with a mean age of 67 years. The primary cancers included 56 PC and 22 BTC cases. Partial resection was performed in 52 patients, segmentectomy in 16, and lobectomy in 10. Five-year OS was 38.3% (43.2% for PC and 28.1% for BTC). Five-year PmFS was 28.3% (28.4% for PC and 27.7% for BTC). The median DFI was 36.0 months (21.0-47.5 months, interquartile range). Larger metastases (> 2 cm) were significantly associated with a poorer survival (hazard ratio, 2.03; 95% confidence interval, 1.06-3.90, p = 0.03). CONCLUSION: Lung metastasectomy may be a viable treatment option for select patients with pancreatobiliary carcinoma, particularly those with smaller metastases.