The role of surgery in renal cell carcinoma with pancreatic metastasis

Abstract

Metastasis of renal cell carcinoma to the pancreas is uncommon and, in most cases, presents as a single pancreatic mass that shows a more favorable prognosis than primary pancreatic tumors. We examined patients with renal cell carcinoma metastatic to the pancreas, and discuss the clinical findings, treatment administered, and final outcomes. The present study is a retrospective analysis of renal cell carcinoma patients with pancreatic metastasis. Pancreatic tumor specimens were obtained by surgical excision, surgical biopsy, fine-needle biopsy, or endoscopic ultrasound biopsy. The surgical approaches included distal splenopancreatectomy, total pancreatectomy, or distal pancreatectomy. The physician determined the postoperative treatment regimen with interferon-α or targeted therapy on the basis of patient's performance. A total of six patients with median age of 50 years were included in the study. The median time from the primary nephrectomy to the development of pancreatic metastasis was 16 years. In the biopsy-only group, the mean stable disease period was 16.5 months. In the patients treated with surgery combined with interferon-α or targeted therapy, the mean stable disease period was 29.5 months. The patients treated with repeat mastectomy showed a mean stable disease period of 33.3 months. Aggressive surgical management is more effective than observation or immunotherapy. Recent advances in the design of targeted therapies may provide alternative treatment strategies. Combination therapy may play an important role in the future. Considering patient compliance and cost-effectiveness, resection of pancreatic metastasis is currently the first choice of treatment. (Biomed J 2015;38:173-176)

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

“…A total of 30 case reports written in English, describing 50 patients, were identified 12367891011121314151617. Patient demographics and presentations are listed in Table 1.…”

Observations on Solitary Versus Multiple Isolated Pancreatic Metastases of Renal Cell Carcinoma: Another Indication of a Seed and Soil Mechanism?

“…Since the results in that regard were already previously presented in detail [24,25], the results updated with the new included cases [130,134,143,153,159,165,167,169,170,173,176,182,184,185,186,187,188,189,190,191,192,193,194] are listed here in the form of a summary.…”

“…In general, the lymphatic system is rarely involved with isPM. Regional lymph node metastases were only present at the time of renal carcinoma surgery in 7.1% of the reports communicated [74,150,160,175,176], and at the time of pancreas metastases surgery, paraaortal lymph nodes were reported only once [142], and peripancreatic lymph nodes were found in only 18 of 309 reports (5.8%) [124,152,163,172,174,177]. That makes a great significance of a lymphatic tumor cell transport with isPM seem unlikely.…”

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

“…A comparable dominance of the systemic hematogenous pathway was also documented in the reports detailing the fate of patients after successful isPM surgery. Of 116 metachronous metastases (6, 16, 28, 35, 47, 57, 58, 69, 70, 72, 74, 82, 84-86, 90, 94, 108, 112, 118, 123, 126, 128, 136, 139-141, 149, 159, 160, 166, 168, 173, 175, 176, 178, 180, 181, 183, 187, 198, 203, 204, 218) 76.7% were undoubtedly of systemic hematogenous origin and in no more than 23.3% of the cases, a local pathway had to be taken into consideration (72,84,108,139,140,160,166,175,180,181,183,187,198). In sum, for metastases that occurred both before and after pancreatic surgery those attributable to a systemic hematogenous spread predominated.…”

“…This only leaves a subordinate significance, if any, for the local lymphatic or venous pathway, which is further underlined by the rare involvement of the lymphatic system in isPM (177). Only in 4.0% of isPM specimen lymph node metastases were present at the time of tumor nephrectomy (57,143,163,186,187). More importantly, in the rare lymphatic pathway the isolated occurrence of pancreatic metastases also requires an SSM, which allows the settlement of tumor cells and their growth to metastasis exclusively in the pancreas.…”