Sakamoto Shinya, Matsumura Masaru, Tani Keigo, Nemoto Satoshi, Tsuchida Kazuhito, Koga Fumitaka, Seyama Yasuji
Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Surg Case Rep. 2021 Feb 3;7(1):37. doi: 10.1186/s40792-021-01122-w.
Renal cell carcinoma (RCC) is a primary tumor with the highest frequency of pancreatic metastasis. Although surgical resection can improve the prognosis of some patients with pancreatic metastasis of RCC (PM-RCC), the role of palliative surgery remains unclear. Herein, we described a case of jejunal limb occlusion caused by a tumor thrombus arising from a PM-RCC which was treated by surgical resection.
A 75-year-old, male patient with metastatic RCC was admitted to our hospital with new-onset dysphagia and weight loss. Twenty years earlier he underwent a right nephrectomy with an adrenalectomy for the first surgical resection of RCC, and 12 years ago he underwent a left partial nephrectomy for metachronous primary RCC. Nine years later, multiple pancreatic metastases were detected. After discontinuing interferon therapy, he was followed up at his request without anticancer treatment. Multiple, pulmonary metastases developed 3 years ago, and resection of a brain metastasis was performed 6 months ago. He had also undergone a total gastrectomy with Roux-en Y reconstruction and splenectomy for gastric cancer 23 years ago. Computed tomography revealed a metastatic lesion in the pancreatic tail extending into the jejunal limb, which was obstructed by a tumor thrombus. Jejunal limb resection was performed concomitantly with a distal pancreatectomy as palliative surgery. The jejunal limb remnant was approximately 30 cm long and was re-anastomosed to the esophagus using a circular stapler. Blood perfusion at the anastomotic site was confirmed by indocyanine green fluorescence imaging. He was discharged on postoperative day 24 and was followed in the outpatient clinic. He achieved sufficient oral intake at 8 months postoperatively.
PM-RCC can invade the gastrointestinal tract and cause tumor thrombus formation resulting in bowel occlusion requiring surgical intervention.
肾细胞癌（RCC）是胰腺转移发生率最高的原发性肿瘤。尽管手术切除可改善部分肾细胞癌胰腺转移（PM-RCC）患者的预后，但姑息性手术的作用仍不明确。在此，我们描述了1例由PM-RCC肿瘤血栓引起的空肠袢梗阻并接受手术切除治疗的病例。
1例75岁男性转移性RCC患者因新发吞咽困难和体重减轻入院。20年前，他因首次手术切除RCC接受了右肾切除术加肾上腺切除术，12年前因异时性原发性RCC接受了左肾部分切除术。9年后，检测到多处胰腺转移。停用干扰素治疗后，应其要求进行随访，未进行抗癌治疗。3年前出现多处肺转移，6个月前进行了脑转移瘤切除术。23年前，他还因胃癌接受了全胃切除术加Roux-en Y重建术和脾切除术。计算机断层扫描显示胰尾有一个转移性病变，延伸至空肠袢，被肿瘤血栓阻塞。作为姑息性手术，在进行远端胰腺切除术的同时进行了空肠袢切除术。空肠袢残端约30 cm长，用圆形吻合器重新吻合至食管。通过吲哚菁绿荧光成像确认吻合部位的血液灌注。他于术后第24天出院，并在门诊随访。术后8个月，他实现了充足的经口摄入量。
PM-RCC可侵犯胃肠道并导致肿瘤血栓形成，从而引起肠阻塞，需要手术干预。
