title: Pancreaticojejunostomy with invagination of the punched pancreatic remnant after medial pancreatectomy and enucleation for multiple metastases of renal cell carcinoma: report of a case.
abstract: We report the successful resection of multiple pancreatic metastases of renal cell carcinoma (RCC), achieved by performing medial pancreatectomy and enucleation, preserving as much of the pancreatic parenchyma as possible. Most of the distal remnant pancreas was placed into the jejunal lumen and all three cut surfaces were covered to prevent pancreatic leakage. The postoperative course was uneventful, without any sign of pancreatic fistula. The patient is well without any evidence of recurrence or impairment of exocrine or endocrine pancreatic functions 1 year after surgery. Considering the unusual behavior of RCC metastasis and the difficulty in predicting the pattern of recurrence, we should devise the optimal surgical strategy to provide cancer-free surgical margins and preserve as much of the pancreatic parenchyma as possible.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Deguchi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hiraoka
mesh_terms: D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler