Akatsu Tomotaka, Shimazu Motohide, Aiura Koichi, Ito Yasuhiro, Shinoda Masahiro, Kawachi Shigeyuki, Tanabe Minoru, Ueda Masakazu, Kitajima Masaki, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
Hepatogastroenterology. 2007 Sep;54(78):1836-40.
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.
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.
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 2.0 cm (range: 1.5-4.0 cm) 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).
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.
背景/目的：胰腺切除术对转移性肾细胞癌（RCC）的益处尚不明确。在此，我们研究肾细胞癌胰腺转移患者的临床病理特征及手术结果。
在2000年11月至2005年11月期间于本中心接受胰腺切除术的131例患者中，4例（3例男性，1例女性）在出现胰腺肿瘤时的中位年龄为57岁（范围：52 - 80岁），经组织学证实为肾细胞癌胰腺转移。对这些患者的病历、影像资料、手术记录及病理结果进行回顾性分析。
所有患者均因原发性肾细胞癌接受了根治性肾切除术。病理分期为TNM分期T2N0M0（n = 1）或T3aN0M0（n = 2）（1例患者无相关数据）。肾细胞癌发生于右肾（n = 2）或左肾（n = 2）。肾切除与胰腺转移检测之间的中位间隔时间为84个月（范围：0 - 285个月）。所有患者均无症状，胰腺肿块在常规随访或筛查检查中被发现，中位肿瘤直径为2.0 cm（范围：1.5 - 4.0 cm）。所有胰腺肿瘤在影像学检查中均表现为边界清晰、光滑且血运丰富。均未显示有胰腺外疾病的证据。通过胰体尾切除术（n = 3）或保留幽门的胰十二指肠切除术（n = 1）实现了足够安全切缘的完整切除。术后中位随访期为39个月（范围：4 - 41个月），3例患者存活且无复发证据，1例患者存活但有复发证据。肾切除术后的中位生存期为103个月（范围：40 - 326个月）。
肾细胞癌可能很晚才转移至胰腺，因此，对于有胰腺肿瘤且有肾细胞癌病史的患者，尽管距肾切除已有一段时间，仍应考虑胰腺转移的可能性。本研究获得的经验表明，对于无胰腺外疾病的肾细胞癌患者应尝试进行胰腺转移瘤切除术。
