Clinicopathological features and surgical outcome of isolated metastasis of renal cell carcinoma

Background/Aims: The benefit of pancreatic resection for metastatic renal cell carcinoma (RCC) is poorly defined. Here, we investigate the clinicopathological features and surgical outcome of patients with pancreatic metastasis from RCC. Methodology: Among a total of 131 patients who underwent pancreatic resection at our center between November 2000 and November 2005, four patients (three men, one woman) with a median age of 57 years (range: 52-80 years) at the time of pancreatic tumor presentation, had histologically confirmed metastatic RCC to the pancreas. The medical records, imaging data, surgical records, and pathology findings of these patients were reviewed retrospectively. Results: All patients underwent radical nephrectomy for primary RCC. The pathologic stage was TNM stage T2N0M0 (n = 1) or T3aN0M0 (n = 2) (no data were available on one patient). RCCs developed in the right (n = 2) or left (n = 2) kidney. The median interval between nephrectomy and detection of pancreatic metastasis was 84 months (range: 0-285 months). All patients were asymptomatic, and the pancreatic masses with a median tumor diameter of 2.0cm (range: 1.5-4.0cm) were detected during routine follow-up or screening examinations. All pancreatic tumors were smooth, well-demarcated, and hypervascular on imaging studies. None of them showed evidence of associated extrapancreatic disease. Complete resection with an adequate margin of safety was achieved by distal pancreatectomy (n = 3) or pylorus-preserving pancreatoduodenectomy (n = 1). Within a median follow-up period of 39 months (range: 4-41 months) after the surgery, three patients were alive with no evidence of recurrence, and one patient was alive with evidence of recurrence. The median survival from nephrectomy was 103 months (range: 40-326 months). Conclusions: RCCs may demonstrate very late metastasis to the pancreas, thus the possibility of pancreatic metastasis should be considered when a patient with a pancreatic tumor has a history of RCC, despite the interval since nephrectomy. The experience gained in this study suggests that pancreatic metastasectomy should be attempted for RCC patients without extrapancreatic disease.