MANAGEMENT OF THE PANCREATIC METASTASES FROM RENAL-CELL CARCINOMA - REPORT OF 4 RESECTED CASES

The pancreas is an uncommon site for metastasis from renal cell carcin oma. In most cases, pancreatic metastases occur as part of widespread nodal and visceral involvement, and there is thus evidence of metastat ic disease elsewhere in the body. We present 4 cases with resectable p ancreatic metastases arising from renal cell tumors without involvemen t of the regional lymph nodes at the operation. Three cases out of 4 w ere asymptomatic and the pancreatic metastases were detected by routin e follow-up examination of renal cell carcinoma. Aggressive surgical t reatment for the solitary metastatic lesion is adovocated. Spread of r enal cell carcinoma to the pancreas is, however, via the hematogenous route, and even solitary pancreatic metastasis may be one of the manif estations of the systemic metastasis of renal cell carcinoma. No pancr eatic regional lymph nodes metastases were noted. Pancreatectomy shoul d be undertaken to remove the tumor with adequate resection margins wh ile preserving as much of the gland as possible. The prognosis of panc reatic metastases arising from a renal cell. carcinoma is discussed wi th a review of the literature. Adjuvant chemo- and endocrine therapy s hould also be considered in these cases.