Oligometastatic disease in pancreatic cancer: is there a role for curative-intent surgery? A narrative review.

Current standards of clinical practice recommend systemic chemotherapy but no surgical approach for Stage IV pancreatic ductal adenocarcinoma (PDAC), with expected overall median survival between 3 and 6 months. In the last 20 years, a subset of patients with a limited number of metastases to just one or two organs (liver and/or lungs) and a less aggressive biology and growth ability have been identified and defined as "oligometastases" (OM). The continuous improvement in systemic therapy with the arrival of the multiagent FOLFIRINOX and gemcitabine + nab-paclitaxel and the refinements and advances in surgical techniques have shifted the focus from technical resectability to biological treatment for patients with OM from PDAC. In this review we evaluate the existing evidence for metastasectomy in the liver, lungs, interaortocaval lymph nodes and peritoneum, assessing the potential indications for surgery and contributing with some general rules that can be followed.