Pancreatic Resection for Metastatic Renal Cell Carcinoma to the Pancreas

Abstract

Although extremely rare, for most primary malignancies, the presence of metastases to the pancreas is a harbinger of diffuse systemic involvement. Clear cell renal cell carcinoma (RCC) of the kidney differs in that respect. Metastatic deposits tend to be isolated and diffuse systemic involvement may be absent. An Institutional Review Board-approved retrospective review of three cases of histologically confirmed RCC metastases to the pancreas was performed. We present their preoperative workup, surgical treatment, histopathological findings, and postoperative course. Three patients, all women, underwent distal pancreatectomy and splenectomy. Mean time period between nephrectomy and findings of pancreatic metastasis was 11.6 years. One patient had a major complication with a pancreatic fistula. Two patients have developed extrapancreatic recurrences. Resection of RCC metastases to the pancreas may offer a survival advantage in a select group of patients. Development of metastatic deposits after a prolonged disease-free period may actually be a negative prognostic indicator, implying a rapid and uncontrollable change in tumor biology.