Pancreatic resections for metastases: A twenty-year experience from a tertiary care center

Franco, Gregorio Di; Gianardi, Desirée; Palmeri, Matteo; Furbetta, Niccolò; Guadagni, Simone; Bianchini, Matteo; Bonari, Federica; Sbrana, Andrea; Vasile, Enrico; Pollina, Luca Emanuele; Mosca, Franco; Morelli, Luca

doi:10.1016/j.ejso.2019.11.514

Cited by 20 publications

(32 citation statements)

References 37 publications

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“…16 The available data from patients undergoing surgical resection for PM report favorable outcomes, with 5-year survival rates up to 72%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Assuming 10-year survival is a more pertinent outcome measure, given that the disease course is often indolent, we enrolled patients up to 2008 and made sure that all the subjects still living had an adequately updated recurrence and vital information at the time of data lock. This resulted in a median follow-up of 141 months in the overall population and of 165 months in censored cases.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic metastases (PM) are mostly metachronous to the primary tumor and are typically identified after a disease-free interval of many years. 1 The current treatment options include surgical resection [1][2][3][4][5][6][7][8][9][10][11][12][13][14] or newly introduced biologic agents directed at vascular endothelial growth factor receptor (VEGF-R), tyrosine kinases (TK), or mammalian target of rapamycin (mTOR). [15][16][17] Because of the infrequency of PM, it has been particularly challenging to accrue clinical data supporting one strategy over the other, with no randomized trials of resection versus targeted therapy having been conducted to date.…”

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confidence: 99%

“…The available observational studies and systematic reviews of patients undergoing surgical resection report 5-year survival projections from 33% to 72% at median follow-up times of 24-91 months. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Hypothesizing that the 10-year survival rate might be a more informative outcome measure, we analyzed longterm oncologic outcomes of patients who had the potential for 10 years of follow-up following metastasectomy at two large academic institutions. Unlike previous studies that estimated recurrence and survival using the standard method of Kaplan-Meier, we employed a competing risk analysis to account for death by other causes during followup.…”

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confidence: 99%

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

et al. 2021

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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.

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

et al. 2021

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“…Moreover, we observed a disease recurrence in about half of patients either with single or multiple PMs, confirming a previous study [ 16 ]. However, as reported by Di Franco at al., an aggressive treatment could be taken into consideration also in case of recurrent disease after RCC pancreatic metastases resection and multiple surgical treatment of recurrent RCC metastases, diagnosed during the follow-up [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic surgery for RCC-PMs appears to confer a survival benefit to the patients [ 10 ], and a significantly longer overall survival (OS) when compared to PMs from other primary neoplasms may be achieved (median 109 vs. 36 months, respectively) [ 11 ]. A surgical treatment may have a role in improving OS and disease-free survival (DFS) in patients with RCC-PMs, even in the era of anti-vascular endothelial growth factor agents.…”

Section: Introductionmentioning

confidence: 99%

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Milanetto

Morelli

Franco

et al. 2020

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Background: Pancreatic metastases from renal-cell carcinoma (RCC-PMs) are rare. Surgery may play a role in improving overall (OS) and disease-free survival (DFS). Methods: Clinical-pathological features, surgery and follow-up data of patients with RCC-PMs operated on in three pancreatic surgical centers (2000–2019) were retrospectively evaluated. Results: Thirty-nine patients (21 male/18 female, averaging 65 years) were enrolled. RCC-PMs were metachronous in 36 patients (mean 94 months, up to 24 years after nephrectomy), multiple in 21 patients, and with a median size of 2.5 (range, 0.7–7.5) cm. All the patients underwent pancreatic surgery (33 standard resections, 6 limited resections). Fifteen patients had post-operative complications (morbidity 38.5%). The median DFS was 63 months, and 19 out of 36 patients showed a disease recurrence. The median OS was 134 months, and 13 out of 36 patients were alive with no evidence of disease. At univariate analysis, lymph node positivity (HR 5.1, 95% CI 1.5–18), multi-visceral resection (HR 3.4, 95% CI 1.1–10) and synchronous RCC-PMs (HR 13, 95% CI 3–55) were significantly associated with a short OS. Conclusion: Surgery may allow a DFS up to 17 years in more than one third of patients, even after limited resections. Splenectomy and lymph node dissection are not mandatory.

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Contemporary indications for upfront total pancreatectomy

et al. 2021

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Currently, advances in surgical techniques, improvements in perioperative care, new formulations of intermediate and longacting insulin and of modern pancreatic enzyme preparations have allowed obtaining good short and long-term results and quality of life, especially in high-volume centres in performing total pancreatectomy (TP).Thus, the surgeon's fear in performing TP is not justified and total pancreatectomy can be considered a viable option in selected patients in high-volume centres. The aim of this review was to define the current indications for this procedure, in particular for upfront TP, considering not only the pancreatic disease, but also the surgical approach (open, mini-invasive) and the relationship with vascular resection.

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Pancreatic resections for metastases: A twenty-year experience from a tertiary care center

Cited by 20 publications

References 37 publications

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

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

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Contemporary indications for upfront total pancreatectomy

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