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.
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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.
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