The evidence for resection of pancreatic adenocarcinoma liver metastases is scarce and mostly from retrospective studies. The largest study was the one published by the Association Française de Chirurgie (Adam et al,Hepatic Resection for Noncolorectal Nonendocrine Liver Metastases - Analysis of 1452 Patients and Development of a Prognostic Model. Ann Surg, 2006). In this study 40 patients with exocrine pancreas liver metastases were operated, with a 5-year survival of 25%. In fact, survival was better than for patients with local disease, possibly due to a selection bias.

This means that selected patients with good oncological initial surgery (R0 or at least R1 of retropancreatic tissue), with proper adjuvant therapy and presenting with metachronous liver metastases should be considered for resection in a multidisciplinary setting. Stability of disease under palliative / neoadjuvant chemotherapy and absence of extra-hepatic disease (by PET-CT) are, in my opinion, essential conditions to consider liver resection.

Once liver resection is considered some technical aspects have to be considered. First, exclusion of peritoneal disease during laparotomy, Secondly, postoperative adhesions could make hilar control difficult, namely for the use of hepatic pedicle clamping. And finally, biliostasis should be perfect after resection, since the previous hepaticojejunostomy coud increase bacterial colonization of the bile (increasing the risk of infected biloma) and no endoscopic therapy can be pursued for long-standing bile leak. 

Dear Dr. Zidan, in my opinion there is no debate.

The biology of pancreatic cancer is so aggressive that is no benefit for metastases resection, synchronous of metacronous. Personally I never have seen a patients with metastases form pancreatic cancer that are resectable. Usually in clinical practice, these are multiple and diffuse distributed into the liver. Even if I will see a patient with only one large metastase into the liver (on CT and MRI), with no other lesions on PET/CT,  I will prefer to continue with chemotherapy. 

I am really very interested if is anyone from RG will resect such a patient!

In the setting of multidisciplinary management, and given adequate stability under chemotherapy and absence of extra-hepatic disease, why refuse an attempt at resection of a single liver metastasis? 

The evidence is mostly retrospective, but so is the evidence for resection or colorectal cancer liver metastases.

I just found a nice review about the topic. If we are looking at the table I, the mean overall survival is comparable with non-resected patients. 

The other two original papers concluded that in highly selected patients it might be feasible. 

However, I think that we as a surgeons should look very sincere to our results. Maybe resection come with benefits in highly selected oligometastatic patients, responsive to neoadjuvant or adjuvant chemotherapy. 

Another condition is R0 resection of the primary tumor. As the evidence showed, as much as 60% of resections are R1 resections, if the pathological exam is standardized. 

To conclude, I think that such an aggressive attitude may come with a significant additional morbidity and mortality due to deficiencies to define patients that will benefit from such an approach. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560742/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560742/#r67

http://www.ncbi.nlm.nih.gov/pubmed/25407113

I never performed such kind of operation I have operated on more than 500 patients and no single patient developed a metachronous isolated liver metastasis amenable for resectionh Every patients  presented   multiple liver metastasis .

Not for pancreatic cancer after whipple procedure. I wanted to know what is the time gap between whipple's operation and detection of the liver secondary?

It is not clearly recommended because the dismal prognosis of the great majority of pancreatic cancer