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Table 2. Summary of most recent studies of PDAC patients undergoing metastasectomy for lung metastases
30-day Median OS 2-year survival 5-year survival
Authors Type of Study Year n Morbidity (%)
mortality (%) (months) (months) (months)
Arnaotakis et al. [34] Single Center 2011 9 0% 0% 51.0 40% N/A
Retrospective
Robinson et al. [36] Single Center 2016 29 0% 0% 29.0 N/A N/A
Retrospective
Downs-Canner et al. [37] Single Center 2015 78 N/A N/A 35.6 N/A 18.3
Retrospective
Yamashita et al. [38] Single Center 2015 2 N/A N/A 70.0 N/A N/A
Retrospective
PDAC: pancreatic ductal adenocarcinoma; N/A: not applicable; OS: overall survival

A B

Figure 2. CT chest showing isolated pulmonary metastases initially diagnosed (A) 98 months after curative resection of PDAC and then
(B) 108 months after curative resection of PDAC, showing that the nodule increased in size. The patient underwent wedge resection and
received gemcitabine-based adjuvant chemotherapy for 6 months. The patient remained asymptomatic and tumor-free for a total of 4
years since last pulmonary metastasectomy [40] . CT: computed tomography; PDAC: pancreatic ductal adenocarcinoma

included 9 patients who underwent pulmonary metastasectomy after initial pancreatectomy for stage I or
II PDAC (median time from pancreatectomy to pulmonary metastasectomy of 34 months) compared to a
matched reference group who did not undergo lung resection. The majority of the patients received adjuvant
chemotherapy and radiation. Median overall survival for the pulmonary metastasectomy group was 51
months compared to 23 months for the reference group, P = 0.04. There were no complications or in-hospital
mortality after pulmonary metastasectomy.

A more recent study on isolated pulmonary metastasectomy for PDAC showed similar results. The cohort
included 29 patients who had previously undergone resection of pancreatic cancer who subsequently
underwent lung resection, 55% for isolated pancreatic cancer lung metastases and 45% for primary lung
cancer. Median disease-free interval was 24 months for the pulmonary metastasectomy group vs. 8 months
for the non-metastasectomy patients. Median overall survival after lung resection was 28 months for the
pulmonary metastasectomy group, corresponding to an estimated 5-year overall survival of 37%. There was
[36]
no post-operative morbidity or mortality .

[37]
Downs-Canner et al. evaluated all patients with pulmonary metastases from PDAC at a high-volume
institution in the United States to determine the natural history of this disease process. Median survival for
patients with lung-first metastasis was significantly longer than for patients with synchronous abdominal-
lung metastases or abdominal-first disease. Among patients who underwent pancreatic resection and then