Long-term Outcomes After Surgical Resection of Pancreatic Metastases from Renal Clear-Cell Carcinoma

Giuseppe Malleo, Roberto Salvia, Laura Maggino, Giovanni Marchegiani, Michael D'Angelica, Ronald DeMatteo, Peter Kingham, Alessandra Pulvirenti, Elisabetta Sereni, William R Jarnagin, Claudio Bassi, Peter J Allen, Giovanni Butturini, Giuseppe Malleo, Roberto Salvia, Laura Maggino, Giovanni Marchegiani, Michael D'Angelica, Ronald DeMatteo, Peter Kingham, Alessandra Pulvirenti, Elisabetta Sereni, William R Jarnagin, Claudio Bassi, Peter J Allen, Giovanni Butturini

Abstract

Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival.

Methods: This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up.

Results: The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%.

Conclusion: In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.

Conflict of interest statement

The authors declare no conflict of interest. This paper did not receive financial support.

Figures

Fig. 1
Fig. 1
Predicted cumulative incidence functions for (a) disease recurrence and (b) death by disease following pancreatectomy for metastatic RCC

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