A Case of Simultaneous Recurrence of Colorectal and Pancreatic Metastasis after Surgery for Renal Cell Carcinoma

Abstract

A 61-year-old man who had undergone surgery for renal cell carcinoma 11 years ago was found to be positive for fecal occult blood. CT was performed and tumors were found in the body and tail of the pancreas and liver flexure of the colon. Total colonoscopy showed that the colorectal tumor was a submucosal tumor-like protuberant hypervascular lesion, but a biopsy did not provide a definitive diagnosis. Based on the clinical course, recurrence of renal cell carcinoma with pancreas and colon metastasis was diagnosed. Distal pancreatectomy and partial resection of the transverse colectomy were performed. After surgery, a pancreatic fistula was found, followed by focal peritonitis, omental necrosis, and an intraabdominal abscess. The patient improved with conservative treatment including CT-guided drainage and was discharged from hospital on the 88th postoperative day. Colon metastasis from renal cell carcinoma is extremely rare and metastasis to multiple organs is often observed. In addition to surgical resection, drug therapy with immune checkpoint inhibitors is effective in some cases, but further investigation is needed. In surgical excision of a colorectal tumor in the transverse colon, the pancreatic transection and colonic anastomosis are close to each other, and this may contribute to the relationship between pancreatic fistula and infection.