Abstracts
2000 Digestive Disease Week

# 2307 Renal Cell Carcinoma Metastatic to the Pancreas: Results of Surgical Management.
Taylor A Sohn, Charles J. Yeo, John L. Cameron, Attila Nakeeb, Keith D. Lillemoe, Baltimore, MD, Milwaukee, WI

Background: Metastatic disease is an uncommon cause of a pancreatic mass. Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas. Objective: To report the surgical management and longterm outcome of patients presenting with renal cell carcinoma metastatic to the pancreas. Methods: A retrospective review of patients undergoing pancreatic resection for renal cell carcinomas metastatic to the pancreas or periampullary region between April 1989 and March 1999, inclusive, was performed. Time from initial presentation, other metastatic sites, surgical outcomes and longterm survival were evaluated. Results: In the ten year time period, ten patients underwent pancreatic resection for metastases from renal cell carcinoma. The mean age of the patients was 60.8 years with 70% of patients being male and 90% being white. Six patients underwent pancreaticoduodenectomy, two underwent distal pancreatectomy, while the two remaining patients underwent total pancreatectomy for tumors involving the entire gland. The mean time from nephrectomy for resection of the primary tumor to pancreatic resection for recurrence was seven years (median 7.5 years). The range was zero to thirteen years, with two patients presenting with synchronous metastases to the pancreas. In 90% of the patients the pathologic findings included negative lymph node involvement and negative surgical margins. One patient had tumor involving the retroperitoneal soft tissue, but had negative margins. The mean follow-up was 26 months, with seven patients remaining alive. The Kaplan-Meier actuarial 5-year survival was 60%, with the longest survivor still alive at 117 months following resection. The patient with positive margins and the patient with soft tissue involvement died at 11 and 4 months, respectively following resection. Conclusions: The pancreas is an uncommon site of metastasis for renal cell carcinoma, typically occurring years after treatment of the primary tumor. When the metastatic focus is isolated and can be resected in its entirety, patients can experience 5-year survival in excess of 60%. The current report suggests that isolated pancreatic or periampullary metastases from renal cell carcinoma should be managed aggressively, with complete resection when possible.