Choi Yun Jong, Lee Jin Ho, Lee Cho Rok, Han Woong Kyu, Kang Chang Moo, Lee Woo Jung
Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Ann Hepatobiliary Pancreat Surg. 2017 May;21(2):96-100. doi: 10.14701/ahbps.2017.21.2.96. Epub 2017 May 23.
Advances in surgical techniques and laparoscopic instruments have resulted in the development of laparoscopic pancreatic surgery. Total pancreaticoduodenectomy is performed for treating benign and borderline pancreatic disease involving the whole pancreas. Here, we report a case of metastatic renal cell carcinoma in the pancreas, treated by laparoscopic pylorus-preserving total pancreaticoduodenectomy. A 59-year-old woman was diagnosed with metastatic renal cell carcinoma. Multiple metastatic lesions were found on routine follow-up. She had a history of radical video-assisted right-nephrectomy for renal cell carcinoma (conventional type, pT1) in November 2003, without any recurrence. However, in 2014, a routine health checkup revealed multiple enhancing lesions throughout the pancreas. Positron emission tomography showed a suspicious 4-cm lesion in her left thyroid. Laparoscopic pylorus-preserving total pancreaticoduodenectomy with splenectomy was performed, along with simultaneous left total thyroidectomy with central compartment node dissection for metastatic renal cell carcinomas. The total operation time was 441 min, with an estimated blood loss of 150 ml; no transfusion was administered. Her hospital stay was 12 days. The histopath report confirmed metastatic renal cell carcinoma in the pancreas and left thyroid. Based on literature reviews, we further tried to estimate the oncologic outcome of total pancreatectomy in multiple pancreatic metastasis of renal cell carcinoma. Laparoscopic pylorus-preserving total pancreaticoduodenectomy is feasible and safe, even in cases of metastatic renal cell carcinoma.
手术技术和腹腔镜器械的进步推动了腹腔镜胰腺手术的发展。全胰十二指肠切除术用于治疗累及整个胰腺的良性和临界性胰腺疾病。在此，我们报告一例胰腺转移性肾细胞癌患者，经腹腔镜保留幽门的全胰十二指肠切除术治疗。一名59岁女性被诊断为转移性肾细胞癌。在常规随访中发现多处转移病灶。她曾于2003年11月因肾细胞癌（传统型，pT1）接受了根治性电视辅助右肾切除术，术后无任何复发。然而，2014年的一次常规健康检查发现整个胰腺有多处强化病灶。正电子发射断层扫描显示其左甲状腺有一个可疑的4厘米病灶。实施了腹腔镜保留幽门的全胰十二指肠切除术并切除脾脏，同时对转移性肾细胞癌进行了左甲状腺全切除术及中央区淋巴结清扫。总手术时间为441分钟，估计失血量为150毫升，未输血。她的住院时间为12天。组织病理学报告证实胰腺和左甲状腺存在转移性肾细胞癌。基于文献综述，我们进一步尝试评估肾细胞癌胰腺多发转移时全胰切除术的肿瘤学结局。腹腔镜保留幽门的全胰十二指肠切除术是可行且安全的，即使是在转移性肾细胞癌病例中。
