Background: Metastatic lesions to the pancreas account for less than 2% of pancreatic neoplasms. Outcomes of pancreatic resection for disease-specific metastases are poorly defined due to their low incidence and grouping of multiple tumor types in current series. Renal cell carcinoma appears to be the most common source of pancreatic metastases. Overall 5-year survival rates for unresectable metastatic renal cell carcinoma are typically less than 10%. Our aim is to define the surgical management and outcome of patients with metastatic renal cell carcinoma to the pancreas.
Methods: Retrospective review of all patients who underwent pancreatic resection for metastatic renal cell carcinoma at our institution from January 1990 to November 2007. Analysis included clinical evaluation, operative management, histology, and outcomes.
Results: A total of 32 patients (18 male, 14 female) with a mean age of 68 years (44-82) were identified. Presentation of the pancreatic metastases was metachronous in 31 patients and synchronous in 1. Solitary pancreatic metastases were identified in 21, while 11 patients had multiple pancreatic metastases (range: 1-6). Resection was limited to the pancreas (n=19), involved additional metastatic sites (n=9), or included renal-bed recurrence (n=3). The median interval from nephrectomy to pancreatic resection was 9 years (1-42). Pancreatic resection included distal pancreatectomy (n=26), total pancreatectomy (n=3), and pancreaticoduodenectomy (n=2). R0 resection was accomplished in 31 patients (97%). One patient underwent a palliative (R2) resection. One patient underwent completion pancreatectomy for recurrent pancreatic metastases 55 months after distal pancreatectomy. Perioperative mortality was not observed. Follow-up data was available in 31 patients (97%) for a mean of 53 months. Tumor recurrence was observed in 15 patients (48%), a mean of 29 months (4-96) after pancreatic resection. Disease-free and overall survival following pancreatic resection was 35 and 53 months respectively, with an actual 5-year survival of 42%.
Conclusion: Metastatic renal cell carcinoma is typically associated with poor survival. Pancreatic resection for metastases may offer a survival advantage; however, potential patient selection bias and lack of comparative trials limit validation. Pancreatic resection does appear warranted in selected patients where an R0 resection is possible.