Background/Objectives: There is increasing evidence that a subset of patients with stage IV pancreatic ductal adenocarcinoma (PDAC) and liver-only metastasis may benefit from surgical resection of both the primary tumor and metastatic lesions. Methods: A meta-analysis and systematic review were conducted in patients with stage IV PDAC and hepatic-only metastasis. A comprehensive literature search (January 2015–June 2023) was performed using PubMed with keywords including “pancreatic cancer”, “oligometastatic”, and “surgery”. Results: Sixteen articles were included in the final review and characterized based on patient selection factors and prognostic indicators. Seven studies reported hazard ratios (HRs) or Kaplan–Meier curves for survival in synchronous resected cohorts versus chemotherapy/palliation alone, which indicated a statistically significant survival benefit in the resection cohorts (pooled HR: 0.41, 95% CI: 0.31–0.53,p< 0.01). Prognostic indicators for synchronous and metachronous resection included lower pre-operative CA19-9, negative margin status of the primary tumor, moderate-to-well-differentiated tumors (grades I–II), and receiving pre-operative chemotherapy. Conclusions: Surgical/ablation selection factors are evolving, with priorities on (1) response to induction chemotherapy, (2) ability to achieve R0 resection, and (3) minimally invasive approaches remaining critical to optimal patient selection. Standardized radiologic and tumor marker evaluation and response to neoadjuvant therapy and optimizing performance status are critical to improved outcomes.
背景/目的：越来越多的证据表明，部分IV期胰腺导管腺癌（PDAC）且仅发生肝转移的患者可能从原发肿瘤和转移灶的联合手术切除中获益。方法：针对IV期PDAC且仅发生肝转移的患者进行了一项荟萃分析和系统性综述。通过PubMed数据库进行了全面的文献检索（2015年1月至2023年6月），关键词包括“胰腺癌”、“寡转移”和“手术”。结果：最终纳入16篇文献，并根据患者选择因素和预后指标进行特征分析。其中七项研究报告了同步切除组与单纯化疗/姑息治疗组的风险比（HR）或生存Kaplan-Meier曲线，结果显示切除组具有统计学显著的生存获益（汇总HR：0.41，95% CI：0.31–0.53，p<0.01）。同步切除与异时切除的预后指标包括较低的术前CA19-9水平、原发肿瘤切缘阴性、中高分化肿瘤（I–II级）以及接受术前化疗。结论：手术/消融治疗的选择标准正在不断发展，优先考虑因素包括：（1）对诱导化疗的反应，（2）实现R0切除的能力，以及（3）微创方法对优化患者选择至关重要。标准化的影像学和肿瘤标志物评估、对新辅助治疗的反应以及优化体能状态，对于改善患者预后至关重要。
肿瘤(癌症)患者之家