Surgical resection of synchronous and metachronous metastases from pancreatic adenocarcinoma. Two case reports in the light of recent evidences

Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the western countries for both men and women. Until in 2015, it remains one of the most challenging malignancies with a dismal prognosis and limited therapeutic options. The 5-year survival rate for pancreatic cancer is around 5%, which is the lowest among all different cancer sites. The poor prognosis of PDAC is largely attributed to delayed diagnosis due to nonspecific symptoms in the early stages of the disease, biological aggressiveness leading to rapid metastases, lack of effective screening methods, and resistance to radiation and chemotherapies. In the event of metastases, patients were traditionally referred to palliative treatments. Thanks to continuous progresses in the surgical expertise, synchronous and metachronous metastases resections seem technically feasible nowadays. These reports describe 2 several clinical cases in which patients with Pancreatic Adenocarcinoma, and synchronous and metachronous liver metastases respectively, were treated with a surgical approach. Patients showed a better survival rate compared current data in the literature. Our results, often in conflict with the guidelines and recent evidences, confirm the need for a new vision of the metastases "problem" in patients with Pancreatic Adenocarcinoma.