Systematic review of pancreatic surgery for metastatic renal cell carcinoma

Tanis, Pieter J.; Gaag, Niels A. van der; Busch, Olivier R.; Gulik, Thomas M. van; Gouma, Dirk J.

doi:10.1002/bjs.6606

Cited by 159 publications

(140 citation statements)

References 129 publications

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“…In general, metastasectomies for synchronous metastases are associated with shorter median survival than resection of metachronous metastases; this has been shown in the case of hepatectomy for colorectal metastases [28,29], pulmonary resection for RCC metastases [30] and adrenalectomy for metastatic non-small-cell lung cancer [31]. The previously-mentioned review of case reports and series of pancreatectomy for metastatic RCC suggest that the same principle applies [27]; our data are not consistent with this, but a dedicated study looking specifically at this question remains to be performed. The reason for this association between synchronous metastases and shorter overall survival following metastasectomy remains to be elucidated-it may indicate a more aggressive underlying biology in the primary tumour, or else reflect the increased morbidity following resection of both the primary and the metastasis either simultaneously or in quick succession.…”

Section: Discussionmentioning

confidence: 89%

“…A thorough systematic review in 2009 examined all available case reports and patient series of RCC with pancreatic metastases available at that time, and concluded that patients with such metastases who are fit for surgery should be considered for curative resection [27]. The authors cautioned that patients with early multi-organ metastases might be better managed with observation and neoadjuvant therapy, as early recurrence seemed to predict a more aggressive clinical course.…”

Section: Discussionmentioning

confidence: 99%

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Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aim: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.Methods: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.Results: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a oneyear survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. Conclusions:Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire. Key words:pancreatic metastasis, metastasectomy, pancreatectomy, metastatic renal cell cancer, 3 Introduction:

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…[70][71][72] Cumulative data suggest that pancreatic metastasectomy might be benefi cial in patients with good performance status and one metastatic site. 73 However, 2·8% inhospital mortality after extensive surgery, done as pancreaticoduodenectomy in 35·8% of patients and total pancreatectomy in 19·9% of patients, suggests that morbidity and mortality might outweigh the potential benefi t. In view of the overall low quality of the data, and the substantial surgical morbidity, patients with a short interval to pancreatic metastasis after nephrectomy may be best treated with systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

288

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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“…The majority of them are from clear cell type [26][27][28], and they often present years after initial treatment [9, 10,12].…”

Section: Discussionmentioning

confidence: 99%

“…They can either present as part of disseminated disease or as isolated metastases. Historically, disease response and survival rates in patients on immunotherapy-type systemic therapy have been disappointing [2][3][4][5][6][7][8], and surgical metastasectomy has been advocated in patients with resectable disease as they have shown superior outcomes [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma

Chiu

Razack²,

Maraveyas³

2013

JCT

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Background:The pancreas is an uncommon but recognizable site for metastases from renal cell carcinoma (RCC). Isolated pancreatic RCC metastases are still rarer and often present years after initial nephrectomy. Surgical resection has been the treatment of choice because of superior patient survival compared with traditional immunotherapy. In recent years, the advent of targeted therapy has transformed the outcomes of patients with metastatic RCC although little evidence is available on its effectiveness on this subset of patients. We report our experience of 6 patients with pancreatic RCC metastases. Patients and Methods: Between 2007 and 2012, 6 patients (2 men, 4 women; median age 78 years) were diagnosed to have pancreatic RCC metastases at our institute. The clinical features, treatment and outcomes were examined. Results: All 6 patients had a primary RCC of clear cell type. The median interval between initial curative nephrectomy and re-presentation with pancreatic metastases was 12.5 years. Four patients were asymptomatic at the time of diagnosis, one presented with obstructive jaundice and another with acute gastrointestinal bleed. Four patients had extra-pancreatic disease. All were deemed unsuitable or unfit for surgical metastasectomy. Five patients had a Memorial Sloan-Kettering Cancer Center (MSKCC) score of 1 (moderate risk) and the other patient had a score of 0 (good risk). Two patients were commenced on Sunitinib, one received Pazopanib and one received Temsirolimus. Two patients did not undergo further treatment. Of the 4 patients who underwent targeted therapy, the median follow up was 33 months with a median progression free survival of 16 months. One achieved complete response but recurred soon after treatment was stopped. Targetted therapy was recommenced and the disease remained stable. A second patient had long period of stable disease before disease progression. A third achieved partial response since started on targeted therapy and a fourth had disease progression despite treatment. Of the four patients who underwent systemic therapy, three are still alive at the time of this report. Conclusion: Pancreatic metastasis from RCC is a unique subgroup of disease which runs an indolent course, and a higher incidence in an elderly population. Our results demonstrate that targeted therapy can be efficacious in some patients where surgical resection is not suitable or possible.

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Systematic review of pancreatic surgery for metastatic renal cell carcinoma

Abstract: The actuarial 5-year overall survival rate following pancreatic surgery for RCC metastases was 72.6 per cent, as determined by pooled analysis from published series. Extrapancreatic disease was an independent risk factor for recurrence, but had no significant impact on overall survival.

Cited by 159 publications

References 129 publications

Pancreatectomy for metastatic disease: A systematic review

Pancreatectomy for metastatic disease: A systematic review

Local treatments for metastases of renal cell carcinoma: a systematic review

Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma

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