METASTASES TO THE PANCREAS AND THEIR SURGICAL EXTIRPATION

Background: The pancreas is an unusual but occasionally favored site f or metastases, notably from carcinomas of the kidney and lung. The pan creas may be the only identified locus of spread, and therefore may pr ovide an opportunity for significant palliation or even cure using pan createctomy. Objective: To report the treatment and outcome of patient s presenting with metastases to the pancreas. Design: Five-year survey . Setting: Tertiary referral center. Patients: Ten patients with appar ently isolated metastases to the pancreas were identified from January 1, 1991, to December 31, 1995. All patients were followed up until de ath or to September 1997. Results: The patients had been treated previ ously for carcinoma of the lung (n=4), renal cell carcinoma (n=2), sar coma (n=2), breast carcinoma (n=1), and endometrial carcinoma (n=1). T he interval between primary treatment and presentation of the metastas es averaged 70 months (14-24 months for lung cancer, 10 and 22 years f or renal cell carcinoma, 4 and 6 years for sarcoma, 8 years for breast cancer, and 36 months for endometrial carcinoma). Metastases were ini tially misdiagnosed as primary pancreatic cancers in 7 patients. In 4 patients (those with renal cell cancer and sarcomas), the tumor was co mpletely resected using total pancreatectomy (n=3) or Whipple resectio n (n=1). Survival after diagnosis averaged 22 months. Two of the 4 pat ients undergoing pancreatic resection remain alive and well 20 and 25 months after pancreatectomy. Conclusions: The pancreas may be the pres enting and perhaps sole locus for metastasis, typically years after tr eatment for certain extrapancreatic malignant neoplasms. Recognition a nd surgical treatment can provide worthwhile palliation and long-term survival.