QS32. Value of Pancreatic Resection For Cancer Metastatic To The Pancreas

Michael E DeBakey Department of Surgery, Baylor College of Medicine, The Elkins Pancreas Center, Houston, Texas, USA.
Journal of Surgical Research (Impact Factor: 1.94). 05/2010; 160(2):268-76. DOI: 10.1016/j.jss.2008.04.012
Source: PubMed


Cancer metastatic to the pancreas from other primary sites is uncommon, and it has been treated with an aggressive surgical approach in fit patients when the primary tumor is controlled and the pancreas is the only site of metastatic disease. The value of pancreatic resection in this setting is unclear. The purpose of this study was to review cases of cancer metastatic to the pancreas.
We reviewed our experience with cancer metastatic to the pancreas and the literature regarding resection of pancreatic metastases. Patient and tumor characteristics were summarized using descriptive statistics.
A total of 220 patients with pancreatic metastasis were analyzed. Three patients were selected from our own experience, and 217 were selected from a literature review. In the 127 patients whose symptoms were recorded at the time of presentation, the most common presenting symptoms were jaundice (n = 32, 25.2%) and abdominal pain (n = 25, 19.7%). In the 189 patients for whom the location of the metastasis in the pancreas was revealed, the most common location was the head of the pancreas (n = 79, 41.8%). The primary tumor site was most commonly kidney (n = 155, 70.5%). Surgical resection was attempted in 177 of 220 patients; 135 patients suffering from RCC metastasis also underwent pancreatic resection. In the latter group, a median survival of 70 months was seen, as well as 78% and 65% 2- and 5-year survival rates, respectively. Conclusion: Survival after resection of RCC with isolated metastasis to the pancreas is favorable. However, a more detailed analysis considering outcomes without surgery for each primary tumor site is needed before the value of this aggressive surgical approach can be completely assessed in the general occurrence of pancreatic metastasis.

10 Reads
  • Source
    • "Another review in 2004 showed that the predominant primary tumour was renal cell carcinoma in 150 cases (45%), followed by lung carcinoma in 49 cases (14.7%), breast carcinoma in 25 cases (7.5%), and colon cancer in 22 cases (6.6%).28 Sweeney et al. searched PubMed using the terms “pancreatic metastasis” and “cancer metastatic to the pancreas” after 2004.29 They found that the most common primary tumour site was kidney (70.5%), followed by breast (6.8%), lung (5.9%), and colorectal (5.5%) for 220 patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Few data are available concerning incidence, clinical picture, and prognosis for pancreatic metastases of small cell lung carcinoma. In this paper we review the related literature available in English language. Although pancreatic metastases are generally asymptomatic, they can rarely produce clinical symptoms or functional abnormalities. The widespread use of multi-detector computerised tomography (CT) in contemporary medical practice has led to an increased detection of pancreatic metastases in oncology patients. Tissue diagnosis is imperative because radiological techniques alone are incapable of differentiating them from primary pancreatic tumours. Pancreatic metastases occur in the relative end stage of small cell lung cancer. The main complications of these lesions, although rare, are acute pancreatitis and obstructive jaundice. Early chemotherapy can provide a survival benefit even in patients with mild acute pancreatitis or extrahepatic biliary obstruction.
    Radiology and Oncology 03/2014; 48(1):11-19. DOI:10.2478/raon-2013-0022 · 1.91 Impact Factor
  • Source
    • "The metastatic involvement of the pancreas is most often related to other intra-abdominal malignancies [7], including clear cell kidney cancer, colon cancer, and gastric cancer [12,13]. A report of 1,000 autopsied cases has revealed that for breast cancer the metastatic pancreatic involvement is a rare occurrence ranking at approximately 6% to 11% of all malignancies [5,14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer. A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater's papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater's papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis. This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.
    World Journal of Surgical Oncology 01/2014; 12(1):2. DOI:10.1186/1477-7819-12-2 · 1.41 Impact Factor
  • Source
    • "Renal cell carcinoma (RCC), melanoma, lung cancer, colorectal cancer and breast cancer are known to metastasize to the pancreas [7-11]. Most patients with pancreatic metastases are asymptomatic, whereas some exhibit jaundice or abdominal pain [12]. RCC has an annual incidence of more than 30,000 a year in the United States, and localized disease is treated via nephrectomy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma. We report the case of a 63-year-old woman, who presented with a pancreatic tumor detected during her annual health examination. She had undergone left nephrectomy 13 years previously for renal cell carcinoma. Computed tomography (CT) revealed two tumors in the head and body of the pancreas, a hypervascular tumor and a hypovascular tumor with an enhanced rim, respectively. She underwent pylorus-preserving pancreaticoduodenectomy, and metastatic pancreatic tumors arising from the kidney with clustered clear cell carcinoma immunohistochemically positive for CD10 were diagnosed. This report presents the different enhancement features of different lesions on CT scans. Because the enhancement features of lesions have been reported to vary according to the size of the metastatic tumor, a knowledge of the history of renal cell carcinoma is crucial for diagnosis.
    World Journal of Surgical Oncology 11/2013; 11(1):289. DOI:10.1186/1477-7819-11-289 · 1.41 Impact Factor
Show more