Unfortunately, surgery cannot and should not be performed in many patients diagnosed with pancreatic cancer, as metastases are already present at the time of diagnosis. Metastases occur when cancer cells have broken away from the primary tumor in the pancreas, have already entered the bloodstream, and have formed new tumors in parts of the liver. Usually, the actual number of metastases tends to be considerably greater than the number of metastases detected by CT or MRI scans. In such cases, chemotherapy is the only appropriate treatment as it targets all visible and invisible (microscopic) foci. Its goal is to slow down the progression of the disease or sometimes reduce (shrink) the cancer foci for a period, resulting in patients’ increased survival. This is very important because, without chemotherapy, the median survival of patients with liver metastases would not exceed 4-6 months. Of course, it should be noted that survival rates vary between patients. Survival rates depend on the biological behavior of each cancer (which may vary between patients as well), the number of metastases, the CA 19-9 tumor marker level, each patient’s overall health, and other factors. 

Very few patients may present with the so-called oligometastatic disease. These patients have 2-3 metastases, respond particularly well to chemotherapy, and could undergo pancreatic cancer resection and liver metastases resection. It should be noted that this is an extremely positive yet rare occurrence that is not the “usual scenario” but rather the exception. However, if a patient is found to belong to this category, the possibility of a simultaneous resection of the pancreatic tumor and liver metastases should not be ruled out. Similarly to major prominent surgery centers in the United States, we have also performed such procedures on carefully selected patients. These patients had excellent survival rates compared to the previously mentioned statistical average.