Renal cell carcinoma metastatic to the pancreas: Results of surgical management

Metastatic tumors to the pancreas are uncommon. Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas. The purpose of the current report is to evaluate the surgical management and long-term outcom e of patients with metastatic renal cell carcinoma. A retrospective review of patients undergoing pancreatic resection for renal cell carcinomas metas tatic to the pancreas or periampullary region between April 1989 and May 19 99, inclusive, was performed. Time from initial presentation, other metasta tic sites, surgical outcomes, and long-term survival were evaluated. During the 10-year time period, 10 patients underwent pancreatic resection for re nal cell carcinoma metastases. Of those, six underwent pancreaticoduodenect omy and two underwent distal pancreatectomy, whereas the two remaining pati ents underwent total pancreatectomy for extensive tumor involvement through out the entire gland. The mean time from nephrectomy for resection of the p rimary tumor to reoperation for periampullary recurrence was 9.8 years (med ian 8.5 years). The range was 0 to 28 years, with one patient presenting wi th a synchronous metastasis. The mean age of the patients was 61.2 years wi th 60% of patients being male and 90% being white. Pathologic findings incl uded histologically negative lymph nodes and negative surgical margins in a ll patients. One patient had tumor involving the retroperitoneal soft tissu e, but final margins were negative. The mean live patient follow-up was 30 months (median = 15 months), with eight patients remaining alive. The Kapla n-Meier actuarial 5-year survival was 75%, with the longest survivor still alive 117 months following resection. The patient with retroperitoneal soft tissue involvement died 4 months after resection. The pancreas is an uncom mon site of metastasis for renal cell carcinoma, typically occurring years after treatment of the primary tumor. When the metastatic focus is isolated and the tumor can be resected in its entirety, patients can experience exc ellent 5-year survival rates. The current report suggests that pancreatic m etastases from renal cell carcinoma should be managed aggressively with com plete resection when possible.