Integrating surgery with chemotherapy may extend survival for some patients with stage IV pancreatic cancer and liver metastases.

• Patients undergoing combined surgery and chemotherapy had a median overall survival of 18 months, whereas those on chemotherapy alone showed significantly less.
• Younger patients (under 65) had a reduced mortality risk (HR = 1.3), and tumor location was a key survival predictor; those with tumors in the body (HR = 0.5) or tail (HR = 0.4) had lower mortality risks than those with head tumors.

Careful patient selection is crucial, as the observed survival benefit may reflect these factors rather than a direct treatment effect.