Randomised controlled trial on the value of surgery on liver metastases originating from pancreatic cancer

Background: Disseminated pancreatic cancer (PC) is common and has a grave prognosis.

However, with the development of local and more effective systemic oncological regimens the treatment options must be re-evaluated. Recent reports indicate prolonged survival after invasive treatment of liver metastases from PC.

A common denominator of improved outcome is that the patients have been preoperatively treated, and responded to chemotherapy.

Preliminary data from the ongoing multicenter ScanPan1 study (NCT05271110) indicates that the proposed treatment with surgery/ablation of liver metastases from PC after at least 4 months of chemotherapy with stable disease/regression is safe and feasible.

The already established and growing collaboration around ScanPan1 forms a unique basis for the proposed project.Purpose: To prospectively and in randomized settings investigate the efficacy, clinical outcomes and quality of life after invasive treatment as an adjunct to neoadjuvant chemotherapy in disseminated pancreatic cancer with limited metastatic burden.Methods:A multi-center Scandinavian RCT will be set up based on the ongoing ScanPan1 phase II study.

University hospitals with active hepatopancreatobiliary service will participate.

Patients with dissemination of PC only to the liver (a maximum of 4 metastases) will be included at the start of neoadjuvant chemotherapy. Upon response the participants will be randomized to continued chemotherapy only or surgery/ablation.