The best treatment for any pancreas adenocarcinoma that has spread is chemotherapy. This is because chemotherapy will treat all the sites of disease. This is true for liver metastases, lung metastases, and peritoneal disease. Surgery is rarely an option, and for a highly specialized center to consider it, there must be stability of the disease after at least 9 to 12 months of chemotherapy. Rarely, a patient may be considered for surgery with peritoneal disease, but this is in the setting of a clinical trial currently offered at the Mayo Clinic, based on specific guidelines and very little metastatic disease.