Abstracts
1997 Digestive Disease Week

Metastases to the pancreas and their surgical extirpation.

K Z'graggen, AL Warshaw, H Sigala, DW Rattner, C Fernandez-del Castillo. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

The pancreas is an unusual but occasionally favored site for metastases, notably from carcinomas of the kidney and lung. The pancreas may be the only identified locus of spread, and there may therefore be an opportunity for significant palliation or even cure by pancreatectomy. Methods: Ten patients with apparently isolated metastases to the pancreas were identified in a single practice during a five year survey (Jan, 1991 - Dec, 1995). All patients were followed until death or to the present. Results: Six males and four females with a mean age of 57 years (42-71) had previously been treated for carcinoma of the lung (4), renal cell carcinoma (2), sarcoma (2), breast carcinoma (1) and endometrial carcinoma (1). The presenting clinical symptoms were jaundice (3), acute pancreatitis (3), duodenal obstruction (2), GI bleeding and pain (4). The interval between primary treatment and the presentation of the metastases to the pancreas averaged 70 months: 12 - 24 months for lung cancer, 10 and 22 years for renal cell carcinoma, 4 and 6 years for sarcoma, 8 years for the patient with breast cancer and 24 months for endometrial carcinoma. The pancreatic tumors were initially misdiagnosed as primary pancreatic cancer in 7 patients. FNA gave a definitive diagnosis in only 3 cases. In 4 cases (both renal cell cancers and both sarcomas) the tumor was completely resected by total pancreatectomy (3) or Whipple resection (1). The other 6 patients were stented, bypassed or not operated upon for tumor staged by preoperative CT as unresectable. Survival after diagnosis averaged 24 months. All patients survived more than 1 year. Three patients lived 32, 33, 52 months, and 2 patients remain alive and well. Conclusions: The pancreas may be the presenting and perhaps sole locus for metastasis, typically years after treatment for certain extrapancreatic malignancies. Recognition and surgical treatment can provide worthwhile palliation and long-term survival.