Laparoscopic total pancreatectomy for multiple metastasis of renal cell carcinoma of the pancreas: a case report and literature review

Abstract

Advances in surgical techniques and laparoscopic instruments have resulted in the development of laparoscopic pancreatic surgery. Total pancreaticoduodenectomy is performed for treating benign and borderline pancreatic disease involving the whole pancreas. Here, we report a case of metastatic renal cell carcinoma in the pancreas, treated by laparoscopic pylorus-preserving total pancreaticoduodenectomy. A 59-year-old woman was diagnosed with metastatic renal cell carcinoma. Multiple metastatic lesions were found on routine follow-up. She had a history of radical video-assisted right-nephrectomy for renal cell carcinoma (conventional type, pT1) in November 2003, without any recurrence. However, in 2014, a routine health checkup revealed multiple enhancing lesions throughout the pancreas. Positron emission tomography showed a suspicious 4-cm lesion in her left thyroid. Laparoscopic pylorus-preserving total pancreaticoduodenectomy with splenectomy was performed, along with simultaneous left total thyroidectomy with central compartment node dissection for metastatic renal cell carcinomas. The total operation time was 441 min, with an estimated blood loss of 150 ml; no transfusion was administered. Her hospital stay was 12 days. The histopath report confirmed metastatic renal cell carcinoma in the pancreas and left thyroid. Based on literature reviews, we further tried to estimate the oncologic outcome of total pancreatectomy in multiple pancreatic metastasis of renal cell carcinoma. Laparoscopic pylorus-preserving total pancreaticoduodenectomy is feasible and safe, even in cases of metastatic renal cell carcinoma.

Isolated Pancreatic Metastases of Renal Cell Carcinoma—A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1,034 Observations

“…In summary, this analysis showed that the factor "time of occurrence of metastases" had no influence on OS both when comparing synchronous with metachronous metastases and within the group of metachronous isPM. Comparable results were reported in single institution (177,184) and multicentre reports (182), as well as in two literature reviews (142,194) and in a review of total pancreatectomies in isPM patients (229), which registered no dependence of the results on the interval after a nephrectomy.…”

Pancreatic Metastasis from Prostate Cancer: A Case Report

“…The head of the pancreas (41.8%) is the most common site of pancreatic metastases, followed by the body and tail of the pancreas (34.9%) and the ampulla area (8.9%) [6]. More than half of patients with pancreatic metastases are usually asymptomatic, and most metastases are found during a follow-up treatment of the primary tumour [7]. Patients that are symptomatic often have nonspeci c complaints, such as abdominal pain, anaemia, weight loss, vomiting, jaundice, or bleeding in the digestive tract.…”

Resection of pancreatic metastatic renal cell carcinoma: experience and long-term survival outcome from a large center in China

“…This example illustrates that by closely monitoring blood glucose and providing extra trypsin after total pancreatectomy, the patient could have a better quality of life. In addition to the widely used prognostic factor model from the Memorial Sloan Kettering Cancer Center [ 31 – 33 ], vascular invasion [ 2 ], presence of symptoms [ 34 ], and tumor size more than 3 cm [ 35 ] may be associated with an increased risk of death. However, the localization and number of metastatic lesions have no effect on the site of metastases [ 34 ], which is in line with our current results.…”

“…However, the localization and number of metastatic lesions have no effect on the site of metastases [ 34 ], which is in line with our current results. Although a few researchers believe that lymphadenectomy should be considered for pancreatic metastasis [ 35 ], there is no convincing evidence to indicate that the involvement of lymph nodes in pancreatic metastasis may affect prognosis [ 8 , 36 , 37 ].…”