title: Extended resection in pancreatic metastases: feasibility, frequency, and long-term outcome: a retrospective analysis.
abstract: BACKGROUND
  Metastases to the pancreas are rare, accounting for less then 2% of all pancreatic malignancies. However, both the benefit of extended tumor resection and the ideal oncological approach have not been established for such cases; therefore, we evaluated patients with metastasis to the pancreas who underwent pancreatic resection.
  
  
  METHODS
  Between 1994 and 2012, 676 patients underwent pancreatic surgery in our institution. We retrospectively reviewed patients' medical records according to survival, and surgical and non-surgical complications. Student's t-test and the log-rank test were used for statistical analysis.
  
  
  RESULTS
  Eighteen patients (2.7%) received resection for pancreatic metastases (12 multivisceral resections and 6 standard resections). The pancreatic metastases originated from renal cell carcinoma (n = 10), malignant melanoma (n = 2), neuroendocrine tumor of the ileum (n = 1), sarcoma (n = 1), colon cancer (n = 1), gallbladder cancer (n = 1), gastrointestinal stromal tumor (n = 1), and non-small cell lung cancer (n = 1). The median time between primary malignancy resection to metastasectomy was 83 months (range, 0-228 months). Minor surgical complications (Grade I-IIIa) occurred in six patients (33.3%) whereas major surgical complications (Grade IIIb-V) occurred in three patients (16.6%). No patients died during hospitalization. The median follow-up was 76 months (range, 10-165 months). One-year, 3-year and 5-year survival for standard resection versus multivisceral resection was 83, 50, and 56% versus 83, 66, and 50, respectively. Twelve patients died after a median of 26 months (range, 5-55 months).
  
  
  CONCLUSIONS
  A surgical approach with curative intent is justified in select patients suffering from metastases to the pancreas and offers good long-term survival. The resection of pancreatic metastases of different tumor types was associated with favorable morbidity and mortality when compared with resection of the primary pancreatic malignancies. Our findings also demonstrated that multivisceral resection was feasible, with acceptable long term outcomes, even though morbidity rates tended to be higher after multivisceral resection than after standard resection.
authors.affiliation: Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany. georg.wiltberger@medizin.uni-leipzig.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Wiltberger
authors.affiliation: Department of Surgery, University Hospital Großhadern (LMU), Munich, Germany.
authors.forename: Julian Nikolaus
authors.initials: JN
authors.lastname: Bucher
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Krenzien
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Benzing
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Georgi
authors.initials: G
authors.lastname: Atanasov
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult