title: Seven-year survival after pancreaticoduodenectomy for early recurrent renal cell carcinoma involving the duodenum A case report.
abstract: RCC has a range of clinical manifestations including vague abdominal symptoms, haematuria, flank pain and a palpable abdominal mass. Generally, 25-30% of patients are found to have metastases at diagnosis but a further 30-50% of patients with local disease will develop metastases during the course of their illness. Spread in RCC is lymphatic, haematogenous, transcoelomic or by direct invasion and the most common sites of metastasis in RCC are the lung, lymph nodes, bones and liver. Metastasis to the small intestine is rare and the duodenum is the segment least often affected. RCC metastasis to the duodenum occurs most commonly in the periampullary region, followed by the bulband usually manifest as gastrointestinal bleeding or obstruction. Bleeding may be the first symptom of metastatic disease in patients who have previously undergone nephrectomy for RCC. Survival is better for patients with localized disease compared with those with regional and distant metastases. This report describes a case of duodenal metastasis from RCC in which the patient presented with upper gastrointestinal bleeding and duodenal obstruction and was treated with pancreaticoduodenectomy with an excellent long-term outcome. Long-term survival was better than survival data reported in the current literature. .
  
  
  BACKGROUND
  Duodenal metastasis, Gastrointestinal bleeding, Renal cell carcinoma, Pancreaticoduodenectomy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cannistra'
authors.forename: Michele
authors.initials: M
authors.lastname: Ruggiero
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bonaiuto
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vaccarisi
authors.forename: Agostino
authors.initials: A
authors.lastname: Naso
authors.forename: Raffaele
authors.initials: R
authors.lastname: Grande
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome