A Retrospective Analysis of Preoperative Evaluation and Surgical Resection for Metastatic Tumors of the Pancreas

Abstract

Pancreatectomy might confer a survival benefit in patients with metastatic tumors of the pancreas (MTPs); however, the optimal treatment for MTP has not been established. We reviewed six patients with MTP undergoing pancreatectomy and discussed the clinical features, surgical treatment, and survival. The sites of primary cancer included renal cell carcinoma (RCC) (n = 5; 83.3%) and rectal cancer (n = 1; 16.7%). The median interval between the resection of the primary site and the development of MTP was 157 months (range, 16-180 months). Three (60.0%) of the five cases of MTP-originating RCC and a MTP-originating rectal cancer, biopsy was performed under endoscopic ultrasonography guidance and MTP was pathologically diagnosed. All patients with MTP originating from RCC have remained alive for 3, 13, 18, 18, and 113 months without recurrence after pancreatectomy. In contrast, the patient with MTP originating from rectal cancer developed multiple liver metastases at 7 months after pancreatectomy, and then underwent chemotherapy. A preoperative pathological diagnosis using biopsy under endoscopic ultrasonography guidance was indispensable for the treatment of MTP. Pancreatectomy for MTP conferred a survival benefit in patients with metastatic RCC, whereas a combination of pancreatectomy and chemotherapy might be necessary to improve the prognosis of patients with metastatic colorectal cancer.

Metachronous Pancreatic Metastasis from Rectal Cancer that Masqueraded as a Primary Pancreatic Cancer: A Rare and Difficult-to-Diagnose Metastatic Tumor in the Pancreas

“…The primary cancers that are most frequently responsible for pancreatic metastases are reportedly renal cell carcinoma (54.3–83.3%) and rectal cancer (7.5–16.7%) [2,9,12,20]. The median interval between resection of the primary cancer and development of pancreatic metastases is relatively longer, being reportedly 32.5–157 months [5,7–9,20]. Pancreatic metastases appearing long after the initial surgery (>5 years) have been documented [4].…”

“…Accurate preoperative diagnosis of pancreatic metastasis rather than a primary pancreatic cancer is difficult [7–10,12]. Cytological examination of a fine needle aspirate or pathological examination of a biopsy specimen obtained under endoscopic ultrasonography guidance is useful for preoperative diagnosis [4,8,9,20,21]. In our case, although pathological assessment of a biopsy specimen suggested moderately-differentiated tubular adenocarcinoma, it was not possible to make a definite preoperative diagnosis of pancreatic metastasis originating from rectal cancer, which was regrettable given the impact the diagnosis made on subsequent management.…”

“…Optimal treatment for pancreatic metastasis has not yet been established [5,8,10,15,20]. Pancreatic resection may confer a survival benefit on patients with pancreatic metastases [2,5–10,12–15,20], the 5-year survival rate after this procedure reportedly being approximately 30% [23]. Cases of successfully resected pancreatic metastases from colorectal cancer after multiple resections of metastatic lesions have been reported [2,5–10,12–14,24].…”

“…In the absence of a definitive diagnosis of pancreatic metastasis, it is not possible to select the optimal chemotherapy regimen [13,26]. From the viewpoint of therapeutic strategy, surgical resection of a pancreatic mass is justified not only to make a definitive diagnosis [8,13,26] but also to improve survival [2,5,6,8–10,12–15,20]. The overall survival of patients with stage IV colorectal cancer is approximately 9 months if chemotherapy is not administered after primary resection [17].…”

Tumour Evolution and Seed and Soil Mechanism in Pancreatic Metastases of Renal Cell Carcinoma

“…In autopsy studies, the frequency is estimated at 1.6–11% [ 23 , 24 , 25 , 26 ]. Of 16,614 pancreatic operations due to malignancy listed in 16 clinical reports [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], only 258 were performed for PM, resulting in a frequency of just 1.6%. Renal cell carcinoma (RCC), lung carcinomas, colorectal malignancies, melanomas, and sarcomas were reported as the most common primary malignancies [ 23 , 24 , 29 , 43 , 44 , 45 , 46 ].…”