Conversion Surgery Vs. Palliative Care in Pancreatic Cancer Oligometastatic to the Liver

Inclusion Criteria: * Adult patients aged ≥18 years and ≤75 years (at diagnosis). * Cytologically or histologically confirmed pancreatic adenocarcinoma either resectable or borderline resectable (at diagnosis) according to National Comprehensive Cancer Network (NCCN)4 (see section 5). * Synchronous oligometastatic disease (at diagnosis), defined as a limited number of radiologically documented liver metastases (up to 3 lesions). * No evidence of extrahepatic metastases (at diagnosis.) * Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 (at enrollment) * Partial response or stable disease after completion of first-line chemotherapy, as determined by RECIST 1.1 criteria21 (modified to exclude any % of increase in the sum of diameters of target lesions) (at enrollment). * Decreasing or stable (defined as ≤20% increase) serum CA19-9 level after chemotherapy (at enrollment). * Liver metastases considered resectable (see section 5) or alternatively treatable by needle ablation/microwave once no larger than 20 mm (at enrollment). Exclusion Criteria: * Locally advanced pancreatic cancer according to NCCN4. * Unresectable liver disease (according to multidisciplinary discussion). * Involvement of other organs. * Presence of significant comorbidities precluding surgery. * Pregnancy. * Contraindications to surgical resection. * Prior surgical resection of the primary tumor or liver metastases. * Evidence of extrahepatic metastases. * Inability to provide informed consent or participate in follow-up assessments. * Disease progression as determined by RECIST 1.1 criteria21 (modified to include any % of increase in the sum of diameters of target lesions) after chemotherapy. * Serum CA19-9 level increase \>20% after chemotherapy. Note: Additional specific exclusion criteria may be defined at each participating center based on their institutional guidelines and patient population.