Pancreatectomy for metastatic disease: a systematic review.
OBJECTIVE
Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.


METHODS
A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.


RESULTS
18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a one-year survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16.


CONCLUSIONS
Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire.
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland. Electronic address: hugh.adler@gmail.com.
H
H
Adler
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
C E
CE
Redmond
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
H M
HM
Heneghan
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
N
N
Swan
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
D
D
Maguire
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
O
O
Traynor
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
E
E
Hoti
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
J G
JG
Geoghegan
National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
K C
KC
Conlon
D002277:Carcinoma / Q000556:secondary / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D059146:Metastasectomy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D012509:Sarcoma / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
Metastasectomy; Metastatic renal cell cancer; Pancreatectomy; Pancreatic metastasis