As expected, the patients with metastatic disease at original diagnosis had significantly worse survival than patients who manifested a metachronous metastatic lesion. This finding suggests that the patients with the least tumor burden at diagnosis had the best survival. There was no difference in survival between patients with a solitary metastasis vs multiple metastases before PN. Patients with pancreatic metastasis seem to have the best survival compared to all other metastatic sites. Of the 11 patients who had no evidence of disease, were alive with disease or were dead without disease at last followup only 1 had presented with concomitant metastatic disease at original diagnosis. All but 2 of these patients underwent metastasectomy. Further details regarding these 11 patients are provided in the table.