Metastatic tumors in the pancreas in the modern era.
BACKGROUND
Tumors metastasizing to the pancreas are rare, and published series are limited by few patients treated for extended periods of time. Renal cell cancer (RCC) is the most common primary tumor metastasizing to the pancreas. Our aim was to describe the clinicopathologic characteristics and patient outcomes in a modern series of patients who underwent metastasectomy, with an emphasis on RCC.


METHODS
Retrospective review of all pancreatic resections between January 1993 and October 2009.


RESULTS
We identified 40 patients with a median age of 62 years; 55% were female. Patients most commonly presented with abdominal pain (47.5%). Operations performed included 10 pancreaticoduodenectomies, 1 middle, 23 distal, 3 total pancreatectomies, and 3 enucleations. Primary cancers were RCC (n = 20), ovarian (n = 6), sarcoma (n = 3), colon (n = 3), melanoma (n = 2), and others (n = 6). Median survival for all patients after metastasectomy was 4.4 years. Median survival after metastasectomy for RCC was 8.7 years, and the 5-year actuarial survival was 61%. For RCCs, pancreas was the first site of an extrarenal recurrence in 85% and was synchronous with the primary in 5% of patients. There was no survival difference if the time interval to metastasis was shorter than the median (8.7 years), if tumor nodules were multiple or bigger than the median (3 cm), or if the pancreas was not the first site of metastases.


CONCLUSIONS
An aggressive approach to lesions metastatic to the pancreas is often warranted if the patient can be rendered free of disease. Although patients with RCC can experience long-term survival after metastasectomy, survival is less favorable for other primary tumors.
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Ioannis T
IT
Konstantinidis
Abdulmetin
A
Dursun
Hui
H
Zheng
Jennifer A
JA
Wargo
Sarah P
SP
Thayer
Carlos
C
Fernandez-del Castillo
Andrew L
AL
Warshaw
Cristina R
CR
Ferrone
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000556:secondary; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D012509:Sarcoma / Q000556:secondary; D016896:Treatment Outcome