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Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection?

Zerbi A, Ortolano E, Balzano G, Borri A, Beneduce AA, Di Carlo V

Pancreas Unit, Department of Surgery, S. Raffaele Scientific Institute, V. Olgettina 60, 20132, Milan, Italy. zerbi.alessandro@hsr.it

BACKGROUND: Pancreas is a possible site of metastases from renal cell carcinoma (RCC). The aim of this study was to define the role of surgery in their treatment. METHODS: We retrospectively analyzed 36 patients with pancreatic metastasis from RCC observed between January 1998 and February 2006. Patients were categorized into three risk groups according to the modified Memorial Sloan-Kettering prognostic factors model. RESULTS: Resective surgery was performed in 23 patients, as follows: 11 distal pancreatectomy, 5 enucleation, 4 pancreatoduodenectomy, 2 total pancreatectomy, and 1 middle pancreatectomy. No perioperative mortality was observed; the morbidity rate was 47.8%. All patients who underwent resection belonged to the favorable risk group. Surgical resection was excluded in 13 cases because of locally advanced disease (2 cases) or extrapancreatic disease (11 cases); 5 of these patients were at favorable, 7 at intermediate, and 1 at poor risk. In patients undergoing surgery, the 5-year actuarial survival rate was 88%, and median disease-free survival was 44 months. Patients who did not undergo surgery had a 5-year survival rate of 47%, with a median survival time of 27 months (P = .02). CONCLUSIONS: Patients with pancreatic metastases from RCC belonging to a favorable risk group are candidates for resection, even in the presence of another metastatic site or multifocal pancreatic disease.

Published 11 March 2008 in Ann Surg Oncol, 15(4): 1161-8.
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