spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2022-4-48-60spractice-364Research ArticleСтатьиХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ КАК ФАКТОР УВЕЛИЧЕНИЯ ВЫЖИВАЕМОСТИ ПАЦИЕНТОВ С ПЕЧЁНОЧНЫМИ ОЛИГОМЕТАСТАЗАМИ ПРОТОКОВОЙ АДЕНОКАРЦИНОМЫ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ. КРИТЕРИИ ОТБОРА ПАЦИЕНТОВ. ОБЗОРSURGICAL TREATMENT AS AN INCREASE IN THE SURVIVAL OF PATIENTS WITH LIVER OLIGOMETASTASIS OF DUCTAL ADENOCARCINOMA OF THE PANCREAS. PATIENT SELECTION CRITERIA. REVIEWhttps://orcid.org/0000-0003-0223-3521ШубинА. В.ShubinA. V.

Шубин Андрей Владимирович – к.м.н., старший преподаватель кафедры госпитальной хирургии

ул. Академика Лебедева, д.6, 194044, Санкт-Петербург

Andrey V. Shubin – PhD, Senior Lecturer, Department of Hospital Surgery

st. Academician Lebedeva, 6, 194044, St. Petersburg

shubin-av@mail.ruhttps://orcid.org/0000-0003-2239-287XКазаковА. Д.KazakovA. D.

Казаков Александр Дмитриевич – слушатель ординатуры кафедры госпитальной хирургии

ул. Академика Лебедева, д.6, 194044, Санкт-Петербург

Alexander D. Kazakov – student of the residency at the Department of Hospital Surgery

st. Academician Lebedeva, 6, 194044, St. Petersburg

kazakovad.97@mail.ruhttps://orcid.org/0000-0003-2024-7425ЗагайновЕ. В.ZagainovE. V.

Загайнов Евгений Владимирович – к.м.н., преподаватель кафедры госпитальной хирургии

ул. Академика Лебедева, д.6, 194044, Санкт-Петербург

Evgeniy V. Zagainov – PhD, Lecturer, Department of Hospital Surgery

st. Academician Lebedeva, 6, 194044, St. Petersburg

zagaynov152@mail.ruФГБВОУ ВО Военно-медицинская академия им. С.М. КироваРоссияFederal State Budgetary Educational Institution of Higher Education Military Medical Academy. CM. KirovRussian Federation202208122022044860Copyright © Шубин А.В., Казаков А.Д., Загайнов Е.В., 20222022Шубин А.В., Казаков А.Д., Загайнов Е.В.Shubin A.V., Kazakov A.D., Zagainov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/364

Работа основана на анализе литературных данных, посвящённых проблеме метастатического рака поджелудочной железы, современному представлению о олигометастатической болезни, критериям отбора пациентов с печёночными олигометастазами протоковой аденокарциномы поджелудочной железы для хирургического лечения, а также оценки эффективности лечения.Цель статьи – обзор проблемы диагностики и лечения пациентов с олигометастатической болезнью поджелудочной железы в контексте современного представления о олигометастатической болезни на современном этапе путём критического и конструктивного анализа и сравнения данных отечественных и зарубежных авторов.Согласно данным Глобальной Раковой Обсерватории (Global Cancer Observatory - GLOBOCAN) в мире, за 2020 год заболеваемость раком поджелудочной железы среди мужчин и женщин составила порядка 7,2 и 5,0 на 100 тыс., при летальности в 6,7 и 4,6%, соответственно [1]. При этом в большинстве случаев заболевание диагностируется на III- IV стадии, поэтому результаты лечения остаются неудовлетворительными, 2/3 пациентов погибают в течение 1 года после установки диагноза. «Золотым стандартом» лечения данной группы пациентов сегодня является только системная противоопухолевая терапия по схеме FOLFRINOX, при которой средняя общая выживаемость составляет порядка 11,1 месяцев.Благодаря развитию представлений о механизмах опухолевой прогрессии, совершенствованию диагностических методов и противоопухолевого лечения появилась и активно изучается концепция олигометастатической болезни. Согласно современной теории, данная группа больных с IV стадией опухолевого процесса потенциально может иметь лучший прогноз. Проведён анализ современной отечественной и зарубежной литературы. По данным научных исследований тщательный отбор и проведение комбинированного лечения может значительно увеличить выживаемость данной группы больных. На основании многочисленных исследований некоторыми авторами предложены оптимальные алгоритмы диагностики и лечения пациентов с олигометастатической болезнью поджелудочной железы.

The work is based on the analysis of the literature data on the problems of treating patients with metastatic pancreatic cancer, identifying a group of patients with more favorable treatment prognosis. The objectives of this review are to study diagnostic criteria, to determine the optimal algorithm for the diagnosis and treatment of patients with oligometastatic pancreatic disease. According to the Global Cancer Observatory (GLOBOCAN) in the world, in 2020 the incidence of pancreatic cancer among men and women was about 7.2 and 5.0 per 100 thousand, with a mortality rate of 6.7 and 4.6 %, respectively [1]. At the same time, in most cases, the disease is diagnosed at stage IIIIV, so the results of treatment remain unsatisfactory, 2/3 of patients die within 1 year after the diagnosis is made. The "gold standard" for the treatment of this group of patients today is only systemic antitumor therapy according to the FOLFRINOX regimen, in which the average overall survival is about 11.1 months. Thanks to the development of ideas about the mechanisms of tumor progression, the improvement of diagnostic methods and antitumor treatment, the concept of oligometastatic disease has appeared and is being actively studied. According to the current theory, this group of patients with stage IV tumors can potentially have a better prognosis. The analysis of modern domestic and foreign literature is carried out. According to scientific studies, careful selection and implementation of combined treatment can significantly increase the survival rate of this group of patients. Based on numerous studies, some authors have proposed optimal algorithms for the diagnosis and treatment of patients with oligometastatic pancreatic disease.

онкологияпротоковая аденокарцинома поджелудочной железыгепатопанкреатобилиарная хирургияолигометастатическая болезньoncologyhepatopancreatobiliary surgerypancreatic ductal adenocarcinomaoligometastatic diseasepancreatic cancerReferencesSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3): 209-249. http://doi.org/10.3322/caac.21660Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3): 209-249. http://doi.org/10.3322/caac.21660Guy B. A brief history of cancer: Age-old milestones underlying our current knowledge database nt. J. Cancer. 2015; 136: 2022–2036. http://doi.org/10.1002/ijc.29134Guy B. A brief history of cancer: Age-old milestones underlying our current knowledge database nt. J. Cancer. 2015; 136: 2022–2036. http://doi.org/10.1002/ijc.29134Paget S. The distribution of secondary growths in cancer of the breast. Lancet. 1889; 133:571–573. https://doi.org/10.1016/S0140-6736(00)49915-0Paget S. The distribution of secondary growths in cancer of the breast. Lancet. 1889; 133:571–573. https://doi.org/10.1016/S0140-6736(00)49915-0Ewing G. Neoplastic Diseases: A Treatise on Tumours. 1928; 3: 1127. https://doi.org/10.1002/bjs.1800166126Ewing G. Neoplastic Diseases: A Treatise on Tumours. 1928; 3: 1127. https://doi.org/10.1002/bjs.1800166126Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889 to January, 1894. Johns Hopkins Bull. 1894; 20(5): 497-555. http://doi.org/10.1097/00000658-189407000-00075Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889 to January, 1894. Johns Hopkins Bull. 1894; 20(5): 497-555. http://doi.org/10.1097/00000658-189407000-00075Halsted W. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907; 46:1-19. http://doi.org/10.1097/00000658-190707000-00001Halsted W. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907; 46:1-19. http://doi.org/10.1097/00000658-190707000-00001Fisher B: Laboratory and clinical research in breast cancer-A personal adventure: The David A Karnovsky Memorial Lecture. Cancer Res. 1980; 40:3863-3874.Fisher B: Laboratory and clinical research in breast cancer-A personal adventure: The David A Karnovsky Memorial Lecture. Cancer Res. 1980; 40:3863-3874.Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995; 13(1): 8-10. http://doi.org/10.1200/JCO.1995.13.1.8Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995; 13(1): 8-10. http://doi.org/10.1200/JCO.1995.13.1.8Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H, Timmerman RD. Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: a phase 2 randomized clinical trial. JAMA Oncol. 2018; 4 (1). http://doi.org/10.1001/jamaoncol.2017.3501Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H, Timmerman RD. Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: a phase 2 randomized clinical trial. JAMA Oncol. 2018; 4 (1). http://doi.org/10.1001/jamaoncol.2017.3501Ruers T, Van Coevorden F, Punt CJ, Pierie JE, Borel- Rinkes I, Ledermann JA, Poston G, Bechstein W, Lentz MA, Mauer M, Folprecht G, Van Cutsem E, Ducreux M, Nordlinger B. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst. 2017; 109 (9). http://doi.org/10.1093/jnci/djx015Ruers T, Van Coevorden F, Punt CJ, Pierie JE, Borel- Rinkes I, Ledermann JA, Poston G, Bechstein W, Lentz MA, Mauer M, Folprecht G, Van Cutsem E, Ducreux M, Nordlinger B. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst. 2017; 109 (9). http://doi.org/10.1093/jnci/djx015Gomez DR, Tang C, Zhang J, Blumenschein GR Jr, Hernandez M, Lee JJ, Ye R, Palma DA, Louie AV, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Welsh JW, Gibbons DL, Karam JA, Kavanagh BD, Tsao AS, Sepesi B, Swisher SG, Heymach JV. Local consolidative therapy vs maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J Clin Oncol. 2019; 37:1558–65. http://doi.org/10.1200/JCO.19.00201Gomez DR, Tang C, Zhang J, Blumenschein GR Jr, Hernandez M, Lee JJ, Ye R, Palma DA, Louie AV, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Welsh JW, Gibbons DL, Karam JA, Kavanagh BD, Tsao AS, Sepesi B, Swisher SG, Heymach JV. Local consolidative therapy vs maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J Clin Oncol. 2019; 37:1558–65. http://doi.org/10.1200/JCO.19.00201Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman GS, Warner A, Senan S. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019; 393: 2051–58. http://doi.org/10.1016/S0140-6736(18)32487-5Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman GS, Warner A, Senan S. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019; 393: 2051–58. http://doi.org/10.1016/S0140-6736(18)32487-5Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol. 2018; 36: 446–53. http://doi.org/10.1200/JCO.2017.75.4853Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol. 2018; 36: 446–53. http://doi.org/10.1200/JCO.2017.75.4853Piciucchi M, Stigliano S, Archibugi L, Zerboni G, Signoretti M, Barucca V, Valente R, Fave GD, Capurso G. The neutrophil/ lymphocyte ratio at diagnosis is significantly associated with survival in metastatic pancreatic cancer patients. Int J MolSci. 2017;18(4):730. http://doi.org/10.3390/ijms18040730Piciucchi M, Stigliano S, Archibugi L, Zerboni G, Signoretti M, Barucca V, Valente R, Fave GD, Capurso G. The neutrophil/ lymphocyte ratio at diagnosis is significantly associated with survival in metastatic pancreatic cancer patients. Int J MolSci. 2017;18(4):730. http://doi.org/10.3390/ijms18040730Stevens L, Pathak S, Nunes QM, Pandanaboyana S, Macutkiewicz C, Smart N, Smith AM. Prognostic significance of pre-operative C-reactive protein and the neutrophillymphocyte ratio in resectable pancreatic cancer: Asystematic review. HPB (Oxford). 2015;17(4): 285–91. http://doi.org/10.1111/hpb.12355Stevens L, Pathak S, Nunes QM, Pandanaboyana S, Macutkiewicz C, Smart N, Smith AM. Prognostic significance of pre-operative C-reactive protein and the neutrophillymphocyte ratio in resectable pancreatic cancer: Asystematic review. HPB (Oxford). 2015;17(4): 285–91. http://doi.org/10.1111/hpb.12355Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa- Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19): 1817–25. http://doi.org/10.1056/NEJMoa1011923Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa- Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19): 1817–25. http://doi.org/10.1056/NEJMoa1011923Frigerio I, Regi P, Giardino A, Scopelliti F, Girelli R, Bassi C, Gobbo S, Martini PT, Capelli P, D'Onofrio M, Malleo G, Maggino L, Viviani E, Butturini G. Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol. 2017. 24: 2397–2403. http://doi.org/10.1245/s10434-017-5885-4Frigerio I, Regi P, Giardino A, Scopelliti F, Girelli R, Bassi C, Gobbo S, Martini PT, Capelli P, D'Onofrio M, Malleo G, Maggino L, Viviani E, Butturini G. Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol. 2017. 24: 2397–2403. http://doi.org/10.1245/s10434-017-5885-4Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB 3rd, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O'Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S. Pancreatic adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017; 15(8): 1028–61. http://doi.org/10.6004/jnccn.2017.0131Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB 3rd, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O'Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S. Pancreatic adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017; 15(8): 1028–61. http://doi.org/10.6004/jnccn.2017.0131Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, Van Laethem JL, Conroy T, Arnold D. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26(Suppl 5): 56– 68. http://doi.org/10.1093/annonc/mdv295Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, Van Laethem JL, Conroy T, Arnold D. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26(Suppl 5): 56– 68. http://doi.org/10.1093/annonc/mdv295Казаков А.Д., Соловьева Т.С. Факторы риска несостоятельности панкреатодигестивного анастомоза после панкреатодуоденальной резекции. Известия Российской Военно-медицинской академии. 2019; 1(1): 187-190. [Kazakov A.D., Solovieva T.S. Risk factors of failure pancreatodigestive anastomosis after pancreatoduodenectomy. Izvestia of the Russian Military Medical Academy. 2019; 1(1): 187-190. (In Russ.)]Казаков А.Д., Соловьева Т.С. Факторы риска несостоятельности панкреатодигестивного анастомоза после панкреатодуоденальной резекции. Известия Российской Военно-медицинской академии. 2019; 1(1): 187-190. [Kazakov A.D., Solovieva T.S. Risk factors of failure pancreatodigestive anastomosis after pancreatoduodenectomy. Izvestia of the Russian Military Medical Academy. 2019; 1(1): 187-190. (In Russ.)]Котив Б.Н., Дзидзава И.И., Смородский А.В. Гастропанкреатодуоденальная резекция при погранично резектабельном раке поджелудочной железы. Сборник научных работ III Петербургского международного онкологического форума "Белые ночи 2017". 2017; 216-217. [Kotiv B.N., Dzidzava I.I., Smorodsky A.V. Gastropancreatoduodenal resection for borderline resectable pancreatic cancer. Collection of scientific papers of the III St. Petersburg International Oncological Forum "White Nights 2017". 2017; 216-217. (In Russ.)]Котив Б.Н., Дзидзава И.И., Смородский А.В. Гастропанкреатодуоденальная резекция при погранично резектабельном раке поджелудочной железы. Сборник научных работ III Петербургского международного онкологического форума "Белые ночи 2017". 2017; 216-217. [Kotiv B.N., Dzidzava I.I., Smorodsky A.V. Gastropancreatoduodenal resection for borderline resectable pancreatic cancer. Collection of scientific papers of the III St. Petersburg International Oncological Forum "White Nights 2017". 2017; 216-217. (In Russ.)]Park, J.B.; Kim, Y.H.; Kim, J.; Chang, H.M.; Kim, T.W.; Kim, S.C.; Kim, P.N.; Han, D.J. Radiofrequency ablation of liver metastasis in patients with locally controlled pancreatic ductal adenocarcinoma. J. Vasc. Interv. Radiol. 2012; 23: 635– 641. http://doi.org/10.1016/j.jvir.2012.01.080Park, J.B.; Kim, Y.H.; Kim, J.; Chang, H.M.; Kim, T.W.; Kim, S.C.; Kim, P.N.; Han, D.J. Radiofrequency ablation of liver metastasis in patients with locally controlled pancreatic ductal adenocarcinoma. J. Vasc. Interv. Radiol. 2012; 23: 635– 641. http://doi.org/10.1016/j.jvir.2012.01.080Нартайлаков М.А., Галимов И.И., Шакуров Д.Ф., Логинов М.О., Мирасова Г.Х. Эффективность рентгенэндоваскулярной эмболизации ветви воротной вены при обширных резекциях печени. Хирургическая практика. 2022;(1):33-37. https://doi.org/10.38181/2223-2427-2022-1-33-37 [Nartailakov M.A., Galimov I.I., Shakurov D.F., Loginov M.O., Mirasova G.K. Efficiency portal vein x-ray vascular embolization in extended hepatic resection. Surgical practice. 2022;(1):33-37. (In Russ.) https://doi.org/10.38181/2223-2427-2022-1-33-37]Нартайлаков М.А., Галимов И.И., Шакуров Д.Ф., Логинов М.О., Мирасова Г.Х. Эффективность рентгенэндоваскулярной эмболизации ветви воротной вены при обширных резекциях печени. Хирургическая практика. 2022;(1):33-37. https://doi.org/10.38181/2223-2427-2022-1-33-37 [Nartailakov M.A., Galimov I.I., Shakurov D.F., Loginov M.O., Mirasova G.K. Efficiency portal vein x-ray vascular embolization in extended hepatic resection. Surgical practice. 2022;(1):33-37. (In Russ.) https://doi.org/10.38181/2223-2427-2022-1-33-37]Шостка К. Г., Кузнецов И. М., Арутюнян К. В., Ильин К. С., Кучеренко А. Д., Фёдоров К.С. Выбор лечебной тактики при раке поджелудочной железы с синхронными метастазами в легкие. Вестник хирургии им. И. И. Грекова. 2018; 178(3): 94. [Shostka K. G., Kuznetsov I. M., Arutyunyan K. V., Ilyin K. S., Kucherenko A. D., Fedorov K. S. The choice of treatment tactics for pancreatic cancer with synchronous lung metastases. Bulletin of Surgery. I. I. Grekova. 2018; 178(3): 94. (In Russ.)]Шостка К. Г., Кузнецов И. М., Арутюнян К. В., Ильин К. С., Кучеренко А. Д., Фёдоров К.С. Выбор лечебной тактики при раке поджелудочной железы с синхронными метастазами в легкие. Вестник хирургии им. И. И. Грекова. 2018; 178(3): 94. [Shostka K. G., Kuznetsov I. M., Arutyunyan K. V., Ilyin K. S., Kucherenko A. D., Fedorov K. S. The choice of treatment tactics for pancreatic cancer with synchronous lung metastases. Bulletin of Surgery. I. I. Grekova. 2018; 178(3): 94. (In Russ.)]Шостка К.Г., Кузнецов И.М., Арутюнян К.В., Ильин К.С., Кучеренко А.Д., Федоров К.С. Рак поджелудочной железы с синхронными метастазами в легкие Вестник национального медико-хирургического центра им. Н.И.Пирогова. 2018; 13(2): 166-169. [Shostka K.G., Kuznetsov I.M., Arutyunyan K.V., Ilyin K.S., Kucherenko A.D., Fedorov K.S. Pancreatic cancer with synchronous lung metastases. Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2018; 13(2): 166-169. (In Russ.)]Шостка К.Г., Кузнецов И.М., Арутюнян К.В., Ильин К.С., Кучеренко А.Д., Федоров К.С. Рак поджелудочной железы с синхронными метастазами в легкие Вестник национального медико-хирургического центра им. Н.И.Пирогова. 2018; 13(2): 166-169. [Shostka K.G., Kuznetsov I.M., Arutyunyan K.V., Ilyin K.S., Kucherenko A.D., Fedorov K.S. Pancreatic cancer with synchronous lung metastases. Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2018; 13(2): 166-169. (In Russ.)]Zhao Y, Li J, Li D, Wang Z, Zhao J, Wu X, Sun Q, Lin PP, Plum P, Damanakis A, Gebauer F, Zhou M, Zhang Z, Schlösser H, Jauch KW, Nelson PJ, Bruns CJ. Tumor biology and multidisciplinary strategies of oligometastasis in gastrointestinal cancers. Semin Cancer Biol. 2020; 60: 334-343. http://doi.org/10.1016/j.semcancer.2019.08.026Zhao Y, Li J, Li D, Wang Z, Zhao J, Wu X, Sun Q, Lin PP, Plum P, Damanakis A, Gebauer F, Zhou M, Zhang Z, Schlösser H, Jauch KW, Nelson PJ, Bruns CJ. Tumor biology and multidisciplinary strategies of oligometastasis in gastrointestinal cancers. Semin Cancer Biol. 2020; 60: 334-343. http://doi.org/10.1016/j.semcancer.2019.08.026Нартайлаков М.А., Галимов И.И., Шакуров Д.Ф., Логинов М.О., Мирасова Г.Х. Эффективность рентгенэндоваскулярной эмболизации ветви воротной вены при обширных резекциях печени. Хирургическая практика. 2022;(1):33-37. https://doi.org/10.38181/2223-2427-2022-1-33-37[Nartailakov M.A., Galimov I.I., Shakurov D.F., Loginov M.O., Mirasova G.K. efficiency portal vein x-ray vascular embolization in extended hepatic resection. Surgical practice. 2022;(1):33-37. (In Russ.) https://doi.org/10.38181/2223-2427-2022-1-33-37]Нартайлаков М.А., Галимов И.И., Шакуров Д.Ф., Логинов М.О., Мирасова Г.Х. Эффективность рентгенэндоваскулярной эмболизации ветви воротной вены при обширных резекциях печени. Хирургическая практика. 2022;(1):33-37. https://doi.org/10.38181/2223-2427-2022-1-33-37[Nartailakov M.A., Galimov I.I., Shakurov D.F., Loginov M.O., Mirasova G.K. efficiency portal vein x-ray vascular embolization in extended hepatic resection. Surgical practice. 2022;(1):33-37. (In Russ.) https://doi.org/10.38181/2223-2427-2022-1-33-37]Hackert T, Niesen W, Hinz U, Tjaden C, Strobel O, Ulrich A, Michalski CW, Büchler MW. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2017; 43(2): 358–363. http://doi.org/10.1016/j.ejso.2016.10.023Hackert T, Niesen W, Hinz U, Tjaden C, Strobel O, Ulrich A, Michalski CW, Büchler MW. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2017; 43(2): 358–363. http://doi.org/10.1016/j.ejso.2016.10.023Yang J, Zhang J, Lui W, Huo Y, Fu X, Yang M, Hua R, Wang L, Sun Y. Patients with hepatic oligometastatic pancreatic body/tail ductal adenocarcinoma may benefit from synchronous resection. HPB (Oxford). 2020; 22(1): 91-101 https://doi.org/10.1016/j.hpb.2019.05.015Yang J, Zhang J, Lui W, Huo Y, Fu X, Yang M, Hua R, Wang L, Sun Y. Patients with hepatic oligometastatic pancreatic body/tail ductal adenocarcinoma may benefit from synchronous resection. HPB (Oxford). 2020; 22(1): 91-101 https://doi.org/10.1016/j.hpb.2019.05.015Tachezy M, Gebauer F, Janot M, Uhl W, Zerbi A, Montorsi M, Perinel J, Adham M, Dervenis C, Agalianos C, Malleo G, Maggino L, Stein A, Izbicki JR, Bockhorn M. Synchronous resections of hepatic oligometastatic pancreatic cancer: Disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery. 2016; 160(1): 136-144. https://doi.org/10.1016/j.surg.2016.02.019Tachezy M, Gebauer F, Janot M, Uhl W, Zerbi A, Montorsi M, Perinel J, Adham M, Dervenis C, Agalianos C, Malleo G, Maggino L, Stein A, Izbicki JR, Bockhorn M. Synchronous resections of hepatic oligometastatic pancreatic cancer: Disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery. 2016; 160(1): 136-144. https://doi.org/10.1016/j.surg.2016.02.019Crippa S, Bittoni A, Sebastiani E, Partelli S, Zanon S, Lanese A, Andrikou K, Muffatti F, Balzano G, Reni M, Cascinu S, Falconi M. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol. 2016. 42: 1533–1539. http://doi.org/10.1016/j.ejso.2016.06.398Crippa S, Bittoni A, Sebastiani E, Partelli S, Zanon S, Lanese A, Andrikou K, Muffatti F, Balzano G, Reni M, Cascinu S, Falconi M. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol. 2016. 42: 1533–1539. http://doi.org/10.1016/j.ejso.2016.06.398Ghaffarpasand E., Barrows C., Callery M.P., Moser A.J., Kent T.S. Resection of oligometastatic pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. HBP. 2019; 21(1): 83-87. https://doi.org/10.1016/j.hpb.2019.03.138Ghaffarpasand E., Barrows C., Callery M.P., Moser A.J., Kent T.S. Resection of oligometastatic pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. HBP. 2019; 21(1): 83-87. https://doi.org/10.1016/j.hpb.2019.03.138Kandel P, Wallace MB, Stauffer J, Bolan C, Raimondo M, Woodward TA, Gomez V, Ritter AW, Asbun H, Mody K. Survival of Patients with Oligometastatic Pancreatic Ductal Adenocarcinoma Treated with Combined Modality Treatment Including Surgical Resection: A Pilot Study. Journal of Pancreatic Cancer. 2018; 4(1): 88-94. https://doi.org/10.1089/pancan.2018.0011Kandel P, Wallace MB, Stauffer J, Bolan C, Raimondo M, Woodward TA, Gomez V, Ritter AW, Asbun H, Mody K. Survival of Patients with Oligometastatic Pancreatic Ductal Adenocarcinoma Treated with Combined Modality Treatment Including Surgical Resection: A Pilot Study. Journal of Pancreatic Cancer. 2018; 4(1): 88-94. https://doi.org/10.1089/pancan.2018.0011Hua Y, Wang P, Zhu X, Shen Y, Wang K, Shi W, Lin J, Meng Z, Chen Z., Chen H. Radiofrequency ablation for hepatic oligometastatic pancreatic cancer: An analysis of safety and efficacy. Pancreatology. 2017; 17: 967–973. https://doi.org/10.1016/j.pan.2017.08.072Hua Y, Wang P, Zhu X, Shen Y, Wang K, Shi W, Lin J, Meng Z, Chen Z., Chen H. Radiofrequency ablation for hepatic oligometastatic pancreatic cancer: An analysis of safety and efficacy. Pancreatology. 2017; 17: 967–973. https://doi.org/10.1016/j.pan.2017.08.072Haas M, Heinemann V, Kullmann F, Laubender R, Klose C, Bruns C, Holdenrieder S, Modest D, Schulz C, Boeck S. Prognostic value of CA 19-9, CEA, CRP, LDH and bilirubin levels in locally advanced and metastatic pancreatic cancer: Results from a multicenter, pooled analysis of patients receiving palliative chemotherapy. J Cancer Res Clin Oncol. 2013; 139(4): 681–689. https://doi.org/10.1007/s00432-012-1371-3Haas M, Heinemann V, Kullmann F, Laubender R, Klose C, Bruns C, Holdenrieder S, Modest D, Schulz C, Boeck S. Prognostic value of CA 19-9, CEA, CRP, LDH and bilirubin levels in locally advanced and metastatic pancreatic cancer: Results from a multicenter, pooled analysis of patients receiving palliative chemotherapy. J Cancer Res Clin Oncol. 2013; 139(4): 681–689. https://doi.org/10.1007/s00432-012-1371-3Boeck S, Wittwer C, Heinemann V, Haas M, Kern C, Stieber P, Nagel D, Holdenrieder S. Cytokeratin 19- fragments (CYFRA 21-1) as a novel serum biomarker for response and survival in patients with advanced pancreatic cancer. Br J Cancer. 2013; 108(8): 1684–1694. https://doi.org/10.1038/bjc.2013.158Boeck S, Wittwer C, Heinemann V, Haas M, Kern C, Stieber P, Nagel D, Holdenrieder S. Cytokeratin 19- fragments (CYFRA 21-1) as a novel serum biomarker for response and survival in patients with advanced pancreatic cancer. Br J Cancer. 2013; 108(8): 1684–1694. https://doi.org/10.1038/bjc.2013.158Song J, Chen M, Guo J, Lian S, Xu B. Combined pretreatment serum CA19- 9 and neutrophil-to-lymphocyte ratio as a potential prognostic factor in metastatic pancreatic cancer patients. Medicine (Baltimore). 2018; 97(4). https://doi.org/10.1097/MD.0000000000009707Song J, Chen M, Guo J, Lian S, Xu B. Combined pretreatment serum CA19- 9 and neutrophil-to-lymphocyte ratio as a potential prognostic factor in metastatic pancreatic cancer patients. Medicine (Baltimore). 2018; 97(4). https://doi.org/10.1097/MD.0000000000009707Hang J, Wu L, Zhu L, Sun Z, Wang G, Pan J, Zheng S, Xu K, Du J, Jiang H. Prediction of overall survival for metastatic pancreatic cancer: Development and validation of a prognostic nomogram with data from open clinical trial and real-world study. Cancer Med. 2018; 7(7): 2974–2984. https://doi.org/10.1002/cam4.1573Hang J, Wu L, Zhu L, Sun Z, Wang G, Pan J, Zheng S, Xu K, Du J, Jiang H. Prediction of overall survival for metastatic pancreatic cancer: Development and validation of a prognostic nomogram with data from open clinical trial and real-world study. Cancer Med. 2018; 7(7): 2974–2984. https://doi.org/10.1002/cam4.1573Kim H, Lee J, Paik K, Lee Y, Hwang J, Kim J. Initial metastatic site as aprognostic factor in patients with stage IV pancreatic ductal adenocarcinoma. Medicine (Baltimore). 2015; 94(25). https://doi.org/10.1097/MD.0000000000001012Kim H, Lee J, Paik K, Lee Y, Hwang J, Kim J. Initial metastatic site as aprognostic factor in patients with stage IV pancreatic ductal adenocarcinoma. Medicine (Baltimore). 2015; 94(25). https://doi.org/10.1097/MD.0000000000001012Uppal A, Wightman S, Mallon S, Oshima G, Pitroda S, Zhang Q, Huang X, Darga T, Huang L, Andrade J, Liu H, Ferguson M, Greene G, Posner M, Hellman S, Khodarev N, Weichselbaum R. 14q32-encoded microRNAs mediate an oligometastatic phenotype. Oncotarget. 2015; 6: 3540–3552. https://doi.org/10.18632/oncotarget.2920Uppal A, Wightman S, Mallon S, Oshima G, Pitroda S, Zhang Q, Huang X, Darga T, Huang L, Andrade J, Liu H, Ferguson M, Greene G, Posner M, Hellman S, Khodarev N, Weichselbaum R. 14q32-encoded microRNAs mediate an oligometastatic phenotype. Oncotarget. 2015; 6: 3540–3552. https://doi.org/10.18632/oncotarget.2920Lussier Y, Khodarev N, Regan K, Corbin K, Li H, Ganai S, Khan S, Gnerlich J, Darga T, Fan H, Karpenko O, Paty P, Posner M, Chmura S, Hellman S, Ferguson M, Weichselbaum R. Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs. PLoS One. 2012; 7(12). https://doi.org/10.1371/journal.pone.0050141Lussier Y, Khodarev N, Regan K, Corbin K, Li H, Ganai S, Khan S, Gnerlich J, Darga T, Fan H, Karpenko O, Paty P, Posner M, Chmura S, Hellman S, Ferguson M, Weichselbaum R. Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs. PLoS One. 2012; 7(12). https://doi.org/10.1371/journal.pone.0050141Oshima G, Poli E, Bolt M, Chlenski A, Forde M, Jutzy J, Biyani N, Posner M, Pitroda S, Weichselbaum R, Khodarev N. DNA Methylation Controls Metastasis-Suppressive 14q32- Encoded miRNAs. Cancer Res. 2019; 79(3): 650-662. https://doi.org/10.1158/0008-5472Oshima G, Poli E, Bolt M, Chlenski A, Forde M, Jutzy J, Biyani N, Posner M, Pitroda S, Weichselbaum R, Khodarev N. DNA Methylation Controls Metastasis-Suppressive 14q32- Encoded miRNAs. Cancer Res. 2019; 79(3): 650-662. https://doi.org/10.1158/0008-5472deSouza N, Liu Y, Chiti A, Oprea-Lager D, Gebhart G, Van Beers B, Herrmann K, Lecouvet F. Strategies and technical challenges for imaging oligometastatic disease: Recommendations from the European Organisation for Research and Treatment of Cancer imaging group. Eur J Cancer. 2018; 91: 153-163. https://doi.org/10.1016/j.ejca.2017.12.012deSouza N, Liu Y, Chiti A, Oprea-Lager D, Gebhart G, Van Beers B, Herrmann K, Lecouvet F. Strategies and technical challenges for imaging oligometastatic disease: Recommendations from the European Organisation for Research and Treatment of Cancer imaging group. Eur J Cancer. 2018; 91: 153-163. https://doi.org/10.1016/j.ejca.2017.12.012Guckenberger M, Lievens Y, Bouma A, Collette L, Dekker A, deSouza N, Dingemans A, Fournier B, Hurkmans C, Lecouvet F, Meattini I, Méndez Romero A, Ricardi U, Russell N, Schanne D, Scorsetti M, Tombal B, Verellen D, Verfaillie C, Ost P. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020; 21(1): 18-28. https://doi.org/10.1016/S1470-2045(19)30718-1Guckenberger M, Lievens Y, Bouma A, Collette L, Dekker A, deSouza N, Dingemans A, Fournier B, Hurkmans C, Lecouvet F, Meattini I, Méndez Romero A, Ricardi U, Russell N, Schanne D, Scorsetti M, Tombal B, Verellen D, Verfaillie C, Ost P. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020; 21(1): 18-28. https://doi.org/10.1016/S1470-2045(19)30718-1Damanakis A, Ostertag L, Waldschmidt D, Kütting F, Quaas A, Plum P, Bruns C, Gebauer F, Popp F. Proposal for a definition of "Oligometastatic disease in pancreatic cancer". BMC Cancer. 2019; 19(1): 1261. https://doi.org/10.1186/s12885-019-6448-9Damanakis A, Ostertag L, Waldschmidt D, Kütting F, Quaas A, Plum P, Bruns C, Gebauer F, Popp F. Proposal for a definition of "Oligometastatic disease in pancreatic cancer". BMC Cancer. 2019; 19(1): 1261. https://doi.org/10.1186/s12885-019-6448-9Niesen W, Primavesi F, Gasteiger S, Neoptolemos J, Hackert T, Stättner S. Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy. European Surgery. 2019; 51: 153–164, https://doi.org/10.1007/s10353-019-0589-6Niesen W, Primavesi F, Gasteiger S, Neoptolemos J, Hackert T, Stättner S. Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy. European Surgery. 2019; 51: 153–164, https://doi.org/10.1007/s10353-019-0589-6Wei M, Shi S, Hua J, Xu J, Yu X. Simultaneous resection of the primary tumour and liver metastases after conversion chemotherapy versus standard therapy in pancreatic cancer with liver oligometastasis: protocol of a multicenter, prospective, randomised phase III control trial (CSPAC-1). BMJ Open 2019; 9. https://doi.org/10.1136/bmjopen-2019-033452Wei M, Shi S, Hua J, Xu J, Yu X. Simultaneous resection of the primary tumour and liver metastases after conversion chemotherapy versus standard therapy in pancreatic cancer with liver oligometastasis: protocol of a multicenter, prospective, randomised phase III control trial (CSPAC-1). BMJ Open 2019; 9. https://doi.org/10.1136/bmjopen-2019-033452

The authors declare that there are no conflicts of interest present.