Dodds K, Curry D, Kelly P, O'Rourke D, McClements J
Department of Hepatobiliary and Pancreatic Surgery, Belfast Health and Social Care Trust, Belfast, UK.
Department of Urology Surgery, Belfast Health and Social Care Trust, Belfast, UK.
Ulster Med J. 2024 Dec;93(2):58-66. Epub 2024 Dec 11.
Metastatic tumours to the pancreas are rare but most commonly arise from primary renal cell carcinoma (RCC). Contrary to other metastatic malignancies, metastatic RCC demonstrates indolent behaviour; with a long latency between primary tumour presentation and the development of metastasis, as well as a predilection to isolated pancreas-only disease. As such, pancreatic metastasectomy has evolved as a treatment option for patients with metastatic RCC; reported to associate with improved outcomes in selected patients. The aim of this study was to describe the clinicopathological characteristics and patient outcomes in a series of patients undergoing pancreatic resection for metastatic RCC in a high volume, regional hepatopancreatobiliary (HPB) centre.
Retrospective review of all patients who underwent pancreatic metastasectomy for pathologically-confirmed metastatic RCC over an eighteen-year period. Clinicopathological characteristics and outcomes were collected and analysed.
Fifteen patients underwent pancreatic resection for metastatic RCC between October 2004 and October 2022. Two patients underwent synchronous nephrectomy and pancreatectomy. In thirteen patients, the pancreas was the only site of metastatic disease. For those with metachronous metastases, the median disease-free interval (DFI) was 126 months from initial nephrectomy.Five-year disease-free and overall survival were 32.7 % and 63.3 %, respectively. No clinicopathological factor was found to associate with overall survival (OS); however, patients with synchronous metastatic disease had a significantly shorter disease-free survival (p = 0.029). Similarly, patients with a longer DFI (≥ ten years) between RCC primary and the development of pancreatic metastases had a trend towards improved OS (p = 0.074).Post-operative morbidity and mortality rates were comparable to that of pancreatic surgery for primary pancreatic pathology.
This case series supports the role of pancreatic resection in patients with metastatic RCC, with acceptable rates of morbidity and mortality and favourable patient outcomes. The long DFI between nephrectomy and pancreatic metastases highlights the importance of long-term follow-up for patients diagnosed with RCC.
胰腺转移瘤罕见，但最常见于原发性肾细胞癌（RCC）。与其他转移性恶性肿瘤不同，转移性RCC表现为惰性病程；原发性肿瘤出现与转移发生之间的潜伏期较长，且倾向于仅孤立转移至胰腺。因此，胰腺转移瘤切除术已成为转移性RCC患者的一种治疗选择；据报道，在部分患者中该手术可改善预后。本研究的目的是描述在一家大型区域肝胆胰（HPB）中心接受胰腺切除治疗转移性RCC的一系列患者的临床病理特征和患者预后。
回顾性分析在18年期间所有因病理确诊的转移性RCC接受胰腺转移瘤切除术的患者。收集并分析临床病理特征及预后。
2004年10月至2022年10月期间，15例患者因转移性RCC接受了胰腺切除术。2例患者同期行肾切除术和胰腺切除术。13例患者中，胰腺是唯一的转移部位。对于异时性转移患者，从初次肾切除到出现转移的中位无病间期（DFI）为126个月。5年无病生存率和总生存率分别为32.7%和63.3%。未发现临床病理因素与总生存（OS）相关；然而，同期发生转移的患者无病生存期明显较短（p = 0.029）。同样，RCC原发灶与胰腺转移发生之间DFI较长（≥10年）的患者OS有改善趋势（p = 0.074）。术后发病率和死亡率与原发性胰腺疾病的胰腺手术相当。
本病例系列支持胰腺切除术在转移性RCC患者中的作用，其发病率和死亡率可接受，患者预后良好。肾切除与胰腺转移之间较长的DFI突出了对诊断为RCC的患者进行长期随访的重要性。
