Metastases of renal carcinoma to the pancreas: a rare indication for pancreatic surgery

Background:

Metastases from renal cell carcinoma are rare events during follow-up. Most metastases to the pancreas appear late in the history of the primary tumor and are considered as having a good prognosis after curative resection.

Methods:

We retrieved the indications for pancreatic resections documented in our clinical tumor registry between 1997 and 2016 for patients operated for metastases of renal cell carcinoma. Clinical and pathological as well as survival data were extracted and analyzed.

Results:

We found 17 patients (9 male/8 female) complying with the requirements. The median age of the patients was 70 years (range 36 – 79 years). The median time interval between resection of pancreatic metastases and resection of the primary tumor was 7 years (range 1 – 26 years). Four patients had a second malignancy (colon, prostate, ovary, urinary bladder) after resection of the renal primary and before diagnosis of the pancreatic metastases. Four patients had pulmonary metastases resected, two patients had adrenalectomy, one patient hat orchiectomy, and another thyreoidectomy for metastases of the renal carcinoma before the pancreatic metastases were detected. We performed four pancreatoduodenectomies, ten distal resections, and three total pancreatectomies. One patient needed a revision because of bleeding, hospital mortality was 0%.

In all cases the diagnosis was confirmed by the pathologist. Twelve patients had solitary pancreatic lesions; five patients had two or more.

Our median follow-up time for all patients is 58 (12 – 153) months. At date of last contact, 9 patients were alive. Five of them showed no evidence of disease, four had metastatic disease. Of the eight deceased patients one died 65 months after pancreatic resection from metastases of her ovary carcinoma, two patients died of comorbidities, the others had recurrence of their renal cell carcinomas.

Observed 5- and 10-year survival rates after pancreatic resection were 71% and 41%, resepectively for all patients. Till now, no patients with multiple pancreatic metastases survived five years.

Conclusions:

The resection of renal cell carcinoma metastatic to the pancreas gives patients a good chance for long term survival with a reasonable preoperative risk.