Long-term Outcomes After Surgical Resection of Pancreatic Metastases from Renal Clear-Cell Carcinoma

Abstract

Background Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival. Methods This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up. Results The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%. Conclusion In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

“…The type of surgery performed varied widely depending on the location of the tumor, with PD being the one seen more often. Atypical resection was performed in just 5 patients (4.3%), which differs from other studies in which this rate has been higher [19,20].…”

“…The medical literature on pancreatic resection due to metastasis is limited to isolated cases or retrospective series. However, in select patients, there seems to be a benefit to survival when they undergo surgery, especially in cases where RCC is the primary tumor [3,7,[19][20][21]. However, in select patients, there seems to be a benefit to survival when they undergo surgery, especially in cases where RCC is the primary tumor [3,7,[19][20][21].…”

“…A recent study conducted by the University of Verona and Memorial Sloan Kettering Cancer Center, including 69 patients, the mean interval was 109 months. This slow-growing tumor has a peculiar tropism for the pancreas, in that the ratio of metastases increases in a timedependent manner, reaching a plateau well beyond 10 years from nephrectomy [20,[22][23][24].…”

“…In addition, surgery increases the chances of having a prolonged DFS, something that is not attainable with systemic treatment. Therefore, with a longer followup of patients, the OS is expected to increase [19].The Malleo et al [20] study analyzed the survival of patients with greater than 10 years of follow-up, and concludes that the 10-year cumulative incidence of disease-specific death was 25.5%. The DFI between the primary tumor resection and the finding of pancreatic metastasis has shown to have an impact on OS in our series (p=0.03), as well as in other published studies, such as the one by Alzahrani et al [34], which determined that the 94-month mark was the cutoff point.…”

Role of metastasectomy in the management of renal cell carcinoma

“…With regards to OS, patients with pancreatic metastases fared better than mRCC patients with other metastases (median OS 38.4 months, 95% CI, 18.4-72.0 vs. 20.1 months, 95% CI, 8.7-41.1, respectively; p < 0.001). Finally, mRCC patients with Complications in pancreatic MTX for mRCC are common, including pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, intestinal bleeding, acute respiratory distress syndrome and wound infections (80,82,83). Malleo et al reported a morbidity rate of 34.8% (n = 24) (80) and mortality rate was 2.9% (n = 2) in the perioperative period (80,82,83).…”