Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection?
BACKGROUND
Pancreas is a possible site of metastases from renal cell carcinoma (RCC). The aim of this study was to define the role of surgery in their treatment.


METHODS
We retrospectively analyzed 36 patients with pancreatic metastasis from RCC observed between January 1998 and February 2006. Patients were categorized into three risk groups according to the modified Memorial Sloan-Kettering prognostic factors model.


RESULTS
Resective surgery was performed in 23 patients, as follows: 11 distal pancreatectomy, 5 enucleation, 4 pancreatoduodenectomy, 2 total pancreatectomy, and 1 middle pancreatectomy. No perioperative mortality was observed; the morbidity rate was 47.8%. All patients who underwent resection belonged to the favorable risk group. Surgical resection was excluded in 13 cases because of locally advanced disease (2 cases) or extrapancreatic disease (11 cases); 5 of these patients were at favorable, 7 at intermediate, and 1 at poor risk. In patients undergoing surgery, the 5-year actuarial survival rate was 88%, and median disease-free survival was 44 months. Patients who did not undergo surgery had a 5-year survival rate of 47%, with a median survival time of 27 months (P = .02).


CONCLUSIONS
Patients with pancreatic metastases from RCC belonging to a favorable risk group are candidates for resection, even in the presence of another metastatic site or multifocal pancreatic disease.
Zerbi
Alessandro
A
Pancreas Unit, Department of Surgery, S. Raffaele Scientific Institute, V. Olgettina 60, 20132, Milan, Italy. zerbi.alessandro@hsr.it
Ortolano
Enrico
E
Balzano
Gianpaolo
G
Borri
Anna
A
Beneduce
Aldo Alberto
AA
Di Carlo
Valerio
V
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome