A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Anna Caterina Milanetto, Luca Morelli, Gregorio Di Franco, Alina David, Donata Campra, Paolo De Paolis, Claudio Pasquali, Anna Caterina Milanetto, Luca Morelli, Gregorio Di Franco, Alina David, Donata Campra, Paolo De Paolis, Claudio Pasquali

Abstract

Background: Pancreatic metastases from renal-cell carcinoma (RCC-PMs) are rare. Surgery may play a role in improving overall (OS) and disease-free survival (DFS).

Methods: Clinical-pathological features, surgery and follow-up data of patients with RCC-PMs operated on in three pancreatic surgical centers (2000-2019) were retrospectively evaluated.

Results: Thirty-nine patients (21 male/18 female, averaging 65 years) were enrolled. RCC-PMs were metachronous in 36 patients (mean 94 months, up to 24 years after nephrectomy), multiple in 21 patients, and with a median size of 2.5 (range, 0.7-7.5) cm. All the patients underwent pancreatic surgery (33 standard resections, 6 limited resections). Fifteen patients had post-operative complications (morbidity 38.5%). The median DFS was 63 months, and 19 out of 36 patients showed a disease recurrence. The median OS was 134 months, and 13 out of 36 patients were alive with no evidence of disease. At univariate analysis, lymph node positivity (HR 5.1, 95% CI 1.5-18), multi-visceral resection (HR 3.4, 95% CI 1.1-10) and synchronous RCC-PMs (HR 13, 95% CI 3-55) were significantly associated with a short OS.

Conclusion: Surgery may allow a DFS up to 17 years in more than one third of patients, even after limited resections. Splenectomy and lymph node dissection are not mandatory.

Keywords: PET-CT scan; pancreatectomy; pancreatic neoplasms; renal cell carcinoma.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Macroscopic appearance of a RCC-PM after cutting the specimen; (B) preoperative CT scan (white arrow for the lesion, black star for the pancreatic tail); (C) 68Ga PET-CT of a single 1.2 cm-in size RCC metastasis in the pancreatic body.
Figure 2
Figure 2
Kaplan-Meier estimates for overall survival (OS) (left) and disease-free survival (DFS) (right) of 36 patients after pancreatic surgery for RCC-PM.

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