Surgical Management of Pancreatic Cancer With Liver Metastasis (Oligometastasis)

Pancreatic cancer is one of the most serious forms of cancer. When it has already spread to the liver, treatment usually consists of chemotherapy rather than surgery. However, in recent years, some hospitals have begun removing both the pancreatic tumor and liver metastases during the same operation in carefully selected patients. This approach remains controversial, and it is unclear how often it is performed in everyday clinical practice and whether it is safe. The aim of this study was to better understand current practice patterns in Germany and to evaluate the short-term safety of simultaneous pancreatic and liver surgery. Using nationwide hospital data, we examined all adult patients who underwent pancreatic resection for a malignant pancreatic tumor over a 14-year period. The study was designed to test several key hypotheses. First, we hypothesized that simultaneous resection of pancreatic tumors and liver metastases is not an exceptional event but is already being performed in routine clinical care. Second, we examined whether adding liver surgery increases the risk of dying during the hospital stay compared to pancreatic surgery alone. Third, we investigated whether the extent of liver resection (minor versus major anatomical procedures) influences perioperative risk. Finally, we assessed whether hospital experience and surgical case volume affect patient safety in this complex setting. Because the data were derived from a nationwide administrative registry, the study focuses on short-term outcomes during hospitalization. It does not address long-term survival or the overall oncologic benefit of combined surgery. Instead, the purpose of this analysis is to provide objective real-world data on how frequently this surgical strategy is used and whether it appears to be feasible from a perioperative safety perspective.