Surgical Therapy of Intrapancreatic Metastasis from Renal Cell Carcinoma

Abstract

Background: Pancreatic metastases from renal cell carcinoma (RCC) are clinically rare but highly resectable. The aim of this article is to identify patients who profit from pancreatic resection of RCC despite the invasiveness of the surgery. Methods: Between January 1996 and December 2007, data from 744 patients were collected in a prospective pancreatic surgery database, and patients with metastasis into the pancreas from RCC were identified. Results: Resective surgery was performed in 14 patients with metastasis to the pancreas from RCC. Most patients were clinically asymptomatic. The median interval between primary treatment of RCC and occurrence of pancreatic metastasis was 94 months (range 32–158). The morbidity rate was 42.8%. Patients with a metastasis size <2.5 cm had a much better survival after resection (100 months) than those with a metastasis size >2.5 cm (44 months). Moreover, the number of metastases predicts the survival after resection. Conclusions: In patients with pancreatic metastases from RCC who have only limited disease, complete resection of all lesions can be successfully performed with a low rate of complications. Thus, patients with a history of RCC should be monitored for more than 10 years after nephrectomy to detect recurrence.

Metastatic disease to the pancreas: an imaging challenge

“…In patients with pancreatic metastases from renal cell cancer (RCC) who have only limited disease, complete resection of all lesions can be successfully performed with a low rate of complications [38]. It seems that lesion size and the number of metastases may predict survival after resection, but sufficient data are not available.…”

Isolated Pancreatic Metastases of Renal Cell Carcinoma—A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1,034 Observations

“…Depending on the site of isPM in head, body or tail or diffuse distribution, and on the number of metastasis within the pancreas standardized surgical techniques are recommended in form of duodeno-pancreatectomies, distal pancreatectomies, and total pancreatectomies. It is, however, remarkable that the 50 atypical local resections performed, provided a correct R0 resection was performed (51,70,72,105,109,113,121,139,140,143,147,160,166,177,181,182,186,194,209,222), brought forth survival results which did not differ from standard operative procedures ( Figure 5, P = 0.368). These results were confirmed by two institutional reports (166,177) and one literature review of the last decade (194).…”

“…Since the first casuistic notes on isPM, it has been discussed which metastatic mechanism (MM) could lead to the unusual metastatic behavior, with local MM being discussed first. On one hand, a local lymphogenic metastatic MM (28,72,85,90,143,165,177) with a retrograde lymph drainage (158) toward the pancreas as a consequence of a tumorous blockade of retroperitoneal lymph nodes (28,85,120,143,165) and on the other hand a local venous MM toward the pancreas (28,72,85,90,165,177), which is supposed to take place via draining collateral veins of hypervascularised tumors (28,85,90,120,158), or via pre-existing porto-renal anastomoses (90,158,224), irrespective of whether renal vein thrombosis was present (28).…”

“…This only leaves a subordinate significance, if any, for the local lymphatic or venous pathway, which is further underlined by the rare involvement of the lymphatic system in isPM (177). Only in 4.0% of isPM specimen lymph node metastases were present at the time of tumor nephrectomy (57,143,163,186,187). More importantly, in the rare lymphatic pathway the isolated occurrence of pancreatic metastases also requires an SSM, which allows the settlement of tumor cells and their growth to metastasis exclusively in the pancreas.…”

Pancreatic Metastases from Tumors in the Urogenital Tract

“…At the same time the prognosis of many cancers has improved even in the metastatic situation with the development of more effective drugs and targeted therapies. While some years ago the literature on pancreatic resections for metastases consisted only of case reports and small series that were certainly subject to publication bias, there are meanwhile several larger (10-44 cases of RCC metastases) retrospective series [5,6,12,13,14,15,16,17,18,19,20,21,22,23,24,25] and even systematic reviews [7,8,26,27,28] on surgical resection for pancreatic metastases and RCC (table 2). However, there are still no prospective studies or randomized controlled trials on this topic.…”