Redefining the role of surgical resection in pancreatic cancer with liver oligometastases

Pancreatic cancer is an aggressive malignancy with a poor prognosis. Compre-hensive treatment based on surgical resection can improve prognosis of patients to a great extent. However, a significant challenge had arisen as patients were often diagnosed with distant metas-tases, predominantly liver metastases. Traditionally, patients presenting with metastatic pancreatic cancer have been considered unresectable, leading to palliative systemic chemotherapy as the standard treatment. With the establishment of multiagent chemotherapy protocols in recent years, the feasi-bility of conversion surgery in selected patients with liver oligometastasis following preoperative chemotherapy was reported. Nonetheless, the understanding of pancreatic cancer with liver oligo-metastases remains limited among most physicians, leaving the treatment paradigm of these patients ambiguous. In this review, the authors attempt to define liver oligometastases in pancreatic cancer, assess the safety and oncologic outcome of surgical resection, and explore feasible strategies for conversion surgery from the perspective of biological resectability.