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Metastatic lesions to the pancreas: When is resection reasonable?Chirurg.
2007 Aug 25;
BACKGROUND: The
significance of pancreatic resection for pancreatic metastatic lesions
has not yet been sufficiently investigated. A retrospective analysis
of patients undergoing pancreatic resections for pancreatic metastases
was conducted. MATERIAL AND METHODS: Twenty patients were resected due
to metastatic lesions to the pancreas. Histopathological findings
were: renal cell carcinoma (n=9), colon carcinoma (n=1), malignant
schwannoma (n=2), leiomyosarcoma (n=2), teratocarcinoma (n=1),
adenocarcinoma of the oesophagus (n=1), gallbladder carcinoma (n=1),
malignant melanoma (n=1), gastrointestinal stromal tumor (n=1), and
spindle cell tumor (n=1). Operative procedures were standard
pancreaticoduodenectomy (n=6), pylorus-preserving
pancreaticoduodenectomy (n=6), and distal pancreatectomy (n=8).
RESULT: The overall 5-year survival rate was 61%, for patients with
renal cell carcinoma 100%. CONCLUSION: Pancreatic metastasectomy is a
reasonable therapeutic option in suited patients. Patients with
pancreatic metastases of renal cell carcinoma achieved excellent
prognoses after radical resection.
Pancreatic metastasis of leiomyosarcoma in the right
thigh: a case report.
World J
Gastroenterol. 2007 Feb 21;13(7):1135-7.
Pancreatic tumors
are primary in most of the cases. Pancreatic metastases associated
with other primary malignancies, especially pancreatic metastasis of
leiomyosarcoma, are uncommon. A 66-year-old woman underwent surgical
resection of malignant mesenchymoma (70% osteosarcoma and 30%
leiomyosarcoma) in the right thigh. In the postoperative period, a
pancreatic mass was identified radiologically by abdominal computed
tomography. Pylorus-preserving pancreaticoduodenectomy was performed.
The surgical specimen revealed leiomyosarcoma metastasized to the
pancreas. A metastatic nodule on the remnant pancreatic tail was
discovered 9 mo after the first pancreatic resection, and distal
pancreatectomy was performed. Cases of pancreatic metastasis from
leiomyosarcoma are extremely rare, especially when the tumor was
resectable. We report here a unique case of pancreatic metastasis from
a leiomyosarcoma in the right thigh that had been treated surgically.
Metastasis of rectal adenocarcinoma to the pancreas. Two case reports
and a review of the literature.JOP.
2007 Mar 10;8(2):214-22.
CONTEXT: The vast
majority of pancreatic tumors are of pancreatic origin. Nonetheless, a
variety of extrapancreatic tumors can involve the pancreas and may
manifest with different clinicopathological characteristics. CASE
REPORT: We report on two patients with a history of rectal cancer who
were referred to our department with a pancreatic mass: one patient 2
years after a low anterior resection (TNM stage: pT3 pN0 pM0), the
other patient 2.5 years after an abdominoperineal resection (TNM
stage: pT3 pN1 pM0). In the first case, computed tomography showed a
cystic mass in the pancreas but fine-needle biopsy followed by
cytopathological analysis revealed only necrotic tissue. In the other
patient, magnetic resonance tomography showed a hypodense structure in
the pancreatic body/tail. Suspecting pancreatic tumors, distal
pancreatectomies were carried out. Subsequent histological examination
revealed metastases of rectal cancer in both cases. CONCLUSION: In
patients with a history of a malignant tumor, a newly diagnosed mass
in the pancreas--although rare--should raise the suspicion of
metastatic disease. Surgical resection may be an option for a curative
approach which can be offered to otherwise healthy patients if there
is no evidence of other metastases.
Surgical treatment of metastatic tumors to the pancreas: a single
center experience and review of the literature.World
J Surg. 2006;30(8):1536-42
BACKGROUND:
Unlike primary pancreatic carcinoma, metastases to the pancreas are
rare, and their resection may be performed as palliative treatment.
The aim of this study was to review our experience with the operative
management of pancreatic metastases. MATERIALS AND METHODS: Between
January 1994 and December 2004 13 patients (nine women and four men;
median age: 59 years; range: 36-79 years) were admitted to our
institution with metastatic lesion to the pancreas. The clinical
features of the treatment and results were examined. RESULTS: Primary
tumors were renal cell carcinoma (n=5), lobular carcinoma of the
breast (n=3), endometrioid carcinoma of the ovary (n=1), colonic
adenocarcinoma (n=1), jejunal leiomyosarcoma (n=1), melanoma (n=1),
and non-small-cell lung cancer (n=1). The median interval between
primary tumor and pancreatic metastases was 36 months (range: 5-192
months). Six patients (46%) were asymptomatic, while the other seven
patients presented with jaundice, pain, and duodenal obstruction. Two
patients with extrapancreatic disease underwent palliative surgery,
and the remaining 11 patients underwent operative procedures that
included seven pancreaticoduodenectomy and four distal
pancreatectomies with splenectomy. Postoperative mortality was nil,
and the morbidity rate was 30%. The two patients who underwent
palliative surgery died after 7 and 9 months, respectively. The median
survival of the resected patients was 26 months (range: 13-95 months).
Five patients died of disease, eight are alive at the time of this
report. CONCLUSION: A trend towards improved survival, even if not
statistically significant, was observed in the renal carcinoma
patients reported here. Surgical resection can be performed safely in
selected patients with isolated metastases to the pancreas, achieving
long-term survival as well as good palliation.
Pancreatic resection
for metastatic tumors to the pancreas.J
Surg Oncol. 2003 Jul;83(3):161-6.
BACKGROUND AND
OBJECTIVES: The incidence of metastases to the pancreas is very low.
The benefit of resection of pancreatic metastasis is poorly defined.
In this review we evaluated the outcome of patients undergoing
pancreatic resection for metastatic tumors to the pancreas. METHODS:
Eight patients underwent pancreatic resection for metastatic tumor
from December 1980 to June 2001. The primary cancer was colon
carcinoma (n = 4), renal cell cancer (n = 2), duodenal leiomyosarcoma
(n = 1), and malignant fibrous histiocytoma (n = 1). The median
interval between primary treatment and detection of pancreatic
metastases was 36 months. In two cases pancreatic metastases were
synchronous with the primary tumor. RESULTS: Four patients underwent
pancreatoduodenectomy, two distal pancreatectomy, one total
pancreatectomy, and one median pancreatectomy. Associated resection of
extrapancreatic lesions was performed in four patients, including two
left hepatectomy and two left colectomy. There was no postoperative
mortality, but two patients had a pancreatic and a biliary fistula,
respectively. Survival averaged 23 months (range 14-42 months): four
patients died for metastatic disease from 14 to 42 months after
operation, while four patients are alive and well 14 to 31 months
after surgery. CONCLUSIONS: Pancreatic resection for metastatic
disease to the pancreas should be considered even in selected patients
with limited extrapancreatic disease. Long-term survival or good
palliation may be achieved.
Results after
pancreatic resection for metastatic lesions.Ann
Surg Oncol. 2002 Aug;9(7):675-9.
BACKGROUND:
Unlike primary pancreatic carcinoma, isolated metastatic lesions to
the pancreas are uncommon. Although the value of surgical resection is
poorly documented, resection may be deemed appropriate in selected
cases. The aim of this study was to review our experience with the
operative management of pancreatic metastases. METHODS: Sixteen
patients who underwent pancreatic resection for the treatment of
metastatic disease were identified from a prospective pancreatic
database. The clinical features of and results after resection were
examined. RESULTS: Renal cell carcinoma was the most frequent primary
histopathology (10 of 16; 62%). In the remaining patients, the primary
histopathology was non-small-cell lung cancer (n = 3), sarcoma (n =
1), melanoma (n = 1), or transitional cell carcinoma of the bladder (n
= 1). A prolonged disease-free interval (median, 7.5 years) was
characteristic of most patients. Operative procedures performed
included eight pancreaticoduodenectomies, seven distal
pancreatectomies, and one total pancreatectomy. The operative
mortality was 6%, and the morbidity was 25%. The overall 2- and 5-year
actuarial survival rates were 62% and 25%, respectively. A trend
toward improved survival was observed in the renal cell carcinoma
patients, but this finding was not statistically significant.
CONCLUSIONS: Long-term survival after pancreatic resection for
metastatic disease is achievable, and patients with primary renal cell
carcinoma seem to have a more favorable prognosis. Surgical resection
should thus be offered to selected patients with isolated metastatic
disease to the pancreas.
Renal cell carcinoma
metastatic to the pancreas: results of surgical management.
J Gastrointest Surg. 2001 Jul-Aug;5(4):346-51 .
Metastatic tumors
to the pancreas are uncommon. Renal cell carcinoma is one of the few
tumors known to metastasize to the pancreas. The purpose of the
current report is to evaluate the surgical management and long-term
outcome of patients with metastatic renal cell carcinoma. A
retrospective review of patients undergoing pancreatic resection for
renal cell carcinomas metastatic to the pancreas or periampullary
region between April 1989 and May 1999, inclusive, was performed. Time
from initial presentation, other metastatic sites, surgical outcomes,
and long-term survival were evaluated. During the 10-year time period,
10 patients underwent pancreatic resection for renal cell carcinoma
metastases. Of those, six underwent pancreaticoduodenectomy and two
underwent distal pancreatectomy, whereas the two remaining patients
underwent total pancreatectomy for extensive tumor involvement
throughout the entire gland. The mean time from nephrectomy for
resection of the primary tumor to reoperation for periampullary
recurrence was 9.8 years (median 8.5 years). The range was 0 to 28
years, with one patient presenting with a synchronous metastasis. The
mean age of the patients was 61.2 years with 60% of patients being
male and 90% being white. Pathologic findings included histologically
negative lymph nodes and negative surgical margins in all patients.
One patient had tumor involving the retroperitoneal soft tissue, but
final margins were negative. The mean live patient follow-up was 30
months (median = 15 months), with eight patients remaining alive. The
Kaplan-Meier actuarial 5-year survival was 75%, with the longest
survivor still alive 117 months following resection. The patient with
retroperitoneal soft tissue involvement died 4 months after resection.
The pancreas is an uncommon site of metastasis for renal cell
carcinoma, typically occurring years after treatment of the primary
tumor. When the metastatic focus is isolated and the tumor can be
resected in its entirety, patients can experience excellent 5-year
survival rates. The current report suggests that pancreatic metastases
from renal cell carcinoma should be managed aggressively with complete
resection when possible.
Renal cell carcinoma metastatic to the pancreas: clinical and
radiological features.Mayo
Clin Proc. 2000 Jun;75(6):581-5.
OBJECTIVE: To
review the clinical features, computed tomographic (CT) appearance,
and treatment outcomes in a case series of patients with renal cell
carcinoma (RCC) metastatic to the pancreas. PATIENTS AND METHODS: We
retrospectively reviewed the records of 23 patients (15 men and 8
women) with RCC metastatic to the pancreas, detected by CT examination
between 1986 and 1996. All patients had undergone a previous
nephrectomy for RCC. RESULTS: Isolated mild elevation in liver
function test results (in 5 patients) or in serum amylase level (in 8
patients) was observed. New-onset diabetes was detected in 3 patients.
The CT characteristics of the pancreatic metastases generally
resembled those of primary RCC with well-defined margins and greater
enhancement than normal pancreas with a central area of low
attenuation. The mean interval between resection of the primary RCC
and detection of the pancreatic metastases was 116 months (range,
1-295 months). In 18 patients (78%), the pancreatic metastases were
diagnosed more than 5 years after nephrectomy. The pancreas was the
initial metastatic site in 12 patients (52%). Survival was shortened
with higher tumor grade (mean survival time of 41 months and 10 months
in patients with grade 2 and 3, respectively). Surgical resection was
carried out in 11 patients (7 distal and 3 total pancreatectomies and
1 distal pancreatectomy followed 4 years later by total pancreatectomy),
with 8 patients alive at a mean follow-up of 4 years, 6 of whom
remained free of recurrence. Overall, 12 patients (52%) were alive at
a mean of 42 months after diagnosis of metastatic disease.
CONCLUSIONS: The appearance of metastatic RCC lesions in the pancreas
closely resembles the appearance of primary RCC on CT images.
Pancreatic metastases from RCC are frequently detected many years
after nephrectomy. Patient survival correlates with tumor grade.
Histologic analysis of pancreatic masses in patients with a history of
resected primary RCC is important since the prognosis for RCC
metastatic to the pancreas is much better than that for primary
pancreatic adenocarcinoma.
Renal cell carcinoma metastatic to the pancreas: a single-institution
series and review of the literature.Urology.
2000 Aug 1;56(2):211-5.
OBJECTIVES: To
present a series of 5 patients with solitary metastatic renal cell
carcinoma (RCC) to the pancreas after radical nephrectomy at our
institution and review the published reports of this rare event.
METHODS: A retrospective review of the records of 5 patients with
histologically confirmed RCC metastatic to the pancreas after radical
nephrectomy was performed. A total of 5 patients (4 men, 1 woman) with
a median age of 56 years (range 54 to 68) underwent radical
nephrectomy for primary RCC. The pathologic stage was Robson I (n = 3)
or Robson III (n = 2), with a left-sided tumor occurring in 3 patients
and a right-sided tumor in 2 patients. The median interval from
nephrectomy to the diagnosis of the pancreatic metastasis was 12 years
(range 4 to 15). All patients were symptomatic at presentation,
including weight loss (n = 3), abdominal pain (n = 3), early satiety
(n = 1), steatorrhea (n = 1), and/or hemosuccus pancreaticus (n = 1).
RESULTS: All pancreatic metastases were hypervascular on imaging
studies, and surgical removal was accomplished by
pancreaticoduodenectomy (n = 3), partial pancreatectomy (n = 1), or
subtotal pancreatectomy (n = 1). One patient died of disseminated
disease 12 months after pancreatic resection. Two other patients had
recurrences in the lung (n = 1) at 5 months or the pancreas/liver (n =
1) at 48 months. Both of these patients underwent a second resection
and were disease free at 2 and 12 months afterward. The two remaining
patients were disease free at 7 and 24 months after pancreatic
resection. CONCLUSIONS: RCC is an unpredictable tumor that may
demonstrate very late metastases even from early-stage lesions.
Aggressive surgical management of isolated pancreatic lesions offers a
chance of long-term survival.
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