Pancreatic resection of isolated metastases from nonpancreatic primary cancers.
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.
Reddy
Sushanth
S
Department of Surgery, The Johns Hopkins University, 600 North Wolfe Street, Carnegie 681, Baltimore, Maryland 21287, USA.
Edil
Barish H
BH
Cameron
John L
JL
Pawlik
Timothy M
TM
Herman
Joseph M
JM
Gilson
Marta M
MM
Campbell
Kurtis A
KA
Schulick
Richard D
RD
Ahuja
Nita
N
Wolfgang
Christopher L
CL
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