title: Pancreatic resection of isolated metastases from nonpancreatic primary cancers.
abstract: BACKGROUND
  The goal of this study is to report the safety and efficacy of pancreatic resection for isolated metastatic cancers from nonpancreatic primary disease.
  
  
  METHODS
  We retrospectively identified patients from a single institution's prospectively gathered pancreaticobiliary database from 1970 to 2007 who underwent a pancreatic resection for metastatic disease.
  
  
  RESULTS
  Forty-nine patients were identified with metastatic lesions to the pancreas. Pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 31, 14, and 4 patients, respectively. Pathology distribution was as follows: 21 renal cell carcinoma (RCC), 6 gallbladder cancer, 4 lung cancer, 4 ovarian cancer, 4 sarcoma, 3 melanoma, 2 colon cancer, 1 breast cancer, 1 hepatocellular carcinoma, 1 seminoma, 1 Langerhans cell histiocytosis, and 1 nonpancreatic endocrine cancer. Postoperative morbidity was 48%. There were no perioperative deaths. A statistically significant difference in survival was found between cancer types (P = .007) with median survivals ranging from 4.8 years for RCC to .9 years for melanoma. Univariate analysis demonstrated a survival disadvantage for patients with perineural (hazard ratio [HR] = 5.4, P = .004) and vascular invasion (HR = 4.4, P = .002). The most commonly resected metastatic lesion of the pancreas was RCC. Eighteen of the 23 patients with RCC had a metachronous lesion with a median length between initial operation and pancreatic resection of 9.3 years. Metachronous lesions had a survival similar to that of synchronous lesions (HR = 1.0, P = .98). Vascular invasion (HR = 2.4, P = .007) and lymph node metastases (HR = 24.1, P = .01) were associated with greater mortality.
  
  
  CONCLUSIONS
  Long-term survival can be achieved in patients undergoing resection of isolated metastases to the pancreas.
authors.affiliation: Department of Surgery, The Johns Hopkins University, 600 North Wolfe Street, Carnegie 681, Baltimore, Maryland 21287, USA.
authors.forename: Sushanth
authors.initials: S
authors.lastname: Reddy
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Marta M
authors.initials: MM
authors.lastname: Gilson
authors.forename: Kurtis A
authors.initials: KA
authors.lastname: Campbell
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000473:pathology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome