Pancreatic resection in patients with synchronous extra‐pancreatic malignancy: outcomes and complications

Abstract

Background Patients may present with a resectable pancreatic tumour in the context of a concurrent primary extra‐pancreatic malignancy. These patients pose a dilemma regarding their suitability for surgery. We evaluated our experience with such patients who underwent pancreatic resection with curative intent and detailed their outcomes and rationale for surgical decision‐making. Methods A retrospective review of patients with pancreatic concurrent extra‐pancreatic primary malignancy who underwent pancreatic resection at our institution over a 12‐year period (2005–2016) was performed. Clinical, histopathological and perioperative outcomes were reviewed. Results Ten patients with a median age of 74 years (40–85 years) were identified. Secondary primary tumours included thyroid (n = 2), gastrointestinal (n = 4), small bowel neuroendocrine (n = 1), renal (n = 1) and haematological malignancies (n = 2). Pancreatic tumours included pancreatic ductal adenocarcinomas (n = 6), solid pseudopapillary neoplasms (n = 2) and ampullary carcinomas (n = 2). After a median follow up of 41.3 months (31.3–164 months), 8 of 10 patients were still alive. Two patients died due to metastatic disease from the secondary malignancy (small bowel neuroendocrine tumour and sigmoid colon adenocarcinoma). The post‐operative complication rate was 30% with no perioperative 90‐day mortality. Conclusion Selected patients with a pancreatic and concurrent primary extra‐pancreatic malignancy may undergo curative pancreatic resection with favourable outcomes.

Multiple primary gastrointestinal tumors of gastric, pancreatic and rectal origin; a case report

“…Although less common than GIST, pancreatic adenocarcinoma can similarly exist with other primary malignancies whether in a synchronous or metachronous manner. Furthermore, the second primary site may vary from other GI organs, to genitourinary or hematopeioeitic systems [13] , [14] . Reports show that the presence of a second primary malignancy in a patient with pancreatic cancer may have a survival benefit, a finding that maintained its statistical significance in multivariant analysis [15] .…”