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Long term survival after resection of pancreatic mestastasis from RCC
Timothy B. Brown, MD/PhD, Mohummad M. Siddiqui, MD, Carlos Fernandez-Del Castillo, MD, Francis J. McGovern, MD.
Massachusetts General Hospital, Boston, MA, USA.
Introduction:
RCC is one of the most common tumors leading to a primary pancreatic metastasis. The purpose of the current study was to review the outcomes of surgical resection of pancreatic metastasis from RCC.
Methods:
All patients that had undergone a pancreatic resection for metastatic RCC at the Massachusetts General Hospital between the years 1997-2011 were included in this retrospective case series. All patients had an initial diagnosis of RCC as well as a co-synchronous or metachronous discovery of metastasis to the pancreas. Patients with pancreatic-only metastasis were eligible for pancreatic resection. A Whipple procedure or distal pancreatectomy was utilized for resection of the pancreatic metastasis. Cox proportional hazards model was used to perform multivariate analysis of predictors of earlier pancreatic metastasis.
Results:
A total of 17 patients with mean follow-up of 9.3 years were reviewed. Of the 12 patients with complete long term follow-up, 10 remain alive at the 9.3 year mean follow-up time point. 59% of the patients were male and mean age of diagnosis of the RCC was 60.1 years old. Four of the metastatic invasions into pancreas were identified co-synchronously and 13 were metachronous. The mean time from initial diagnosis of RCC to pancreatic metastasis was 7.8 years. Twelve cases involved solitary metastasis to the pancreas and five ultimately developed metastatic disease elsewhere. The mean size of the pancreatic metastasis was 3.4 cm. The original RCC was clear cell in 85% of patients and chromophobe histology in the remaining 15%. Distal pancreatectomy was used to resect the metastasis in 47% of patients and a Whipple procedure in 41%. An alternative procedure such as enucleation was used in 12%. On multivariate analysis, age and grade of primary RCC were not predictors of time to pancreatic metastasis, however higher stage of disease was a predictor of earlier pancreatic metastasis (HR 5.3, p=0.02).
Conclusion:
In patients with solitary pancreatic metastatic disease from RCC, resection of the pancreatic mass is a viable treatment option with potentially long-term survival.
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