Distribution of liver metastases based on the site of primary pancreatic carcinoma

OBJECTIVES:To investigate whether the different location of pancreatic adenocarcinoma affects the lobar distribution of metastases to the liver.METHODS:From all patients who underwent multidetector computed tomography (MDCT) examinations for staging of pancreatic adenocarcinoma in the last 4 years we selected 80 patients (42 men, 38 women; mean age, 60.56 years) with liver metastases and a pancreatic adenocarcinoma of the head (group A, 40 patients; diameter, 32.41 ± 2.28 mm) or body-tail (group B, 40 patients; diameter, 52.21 ± 2.8 mm). We analysed tumour site, diameter, vascular invasion and number of metastases in each lobe of the liver. The total number of metastases was compared between the two groups with an unpaired t-test, while Fisher's test was used to compare the number of metastases within the two lobes.RESULTS:As expected, the number of liver metastases was higher in group B than in group A. The ratio of metastases in the right-to-left hemi-liver was 7.4:1 for group A compared with 3.3:1 for group B (p < 0.0001).CONCLUSIONS:Although the number of liver metastases is higher in the right lobe than in the left lobe in both groups, there is a significant difference in the ratio of metastases between the right and the left hemi-liver. This supports the existence of a streamline phenomenon and a selective lobar distribution of metastases within the liver.KEY POINTS:• Pancreatic adenocarcinoma presents with liver metastases in 40 % of cases • The presence of liver metastases disqualifies the patient from curative surgery • The distribution of metastases within the liver depends on the site of pancreatic adenocarcinoma • The distribution of liver metastases is due to the streamline phenomenon.