Hashimoto M, Watanabe G, Matsuda M, Dohi T, Tsurumaru M
Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.
Hepatogastroenterology. 1998 Jul-Aug;45(22):1150-4.
The pancreas is an uncommon site for metastasis from renal cell carcinoma. In most cases, pancreatic metastases occur as part of widespread nodal and visceral involvement, and there is thus evidence of metastatic disease elsewhere in the body. We present 4 cases with resectable pancreatic metastases arising from renal cell tumors without involvement of the regional lymph nodes at the operation. Three cases out of 4 were asymptomatic and the pancreatic metastases were detected by routine follow-up examination of renal cell carcinoma. Aggressive surgical treatment for the solitary metastatic lesion is advocated. Spread of renal cell carcinoma to the pancreas is, however, via the hematogenous route, and even solitary pancreatic metastasis may be one of the manifestations of the systemic metastasis of renal cell carcinoma. No pancreatic regional lymph nodes metastases were noted. Pancreatectomy should be undertaken to remove the tumor with adequate resection margins while preserving as much of the gland as possible. The prognosis of pancreatic metastases arising from a renal cell carcinoma is discussed with a review of the literature. Adjuvant chemo- and endocrine therapy should also be considered in these cases.
胰腺是肾细胞癌转移的罕见部位。在大多数情况下，胰腺转移是广泛的淋巴结和内脏受累的一部分，因此身体其他部位有转移疾病的证据。我们报告4例可切除的胰腺转移瘤，其源自肾细胞肿瘤，手术时区域淋巴结未受累。4例中有3例无症状，胰腺转移瘤通过肾细胞癌的常规随访检查发现。主张对孤立性转移病灶进行积极的手术治疗。然而，肾细胞癌转移至胰腺是通过血行途径，即使是孤立性胰腺转移也可能是肾细胞癌全身转移的表现之一。未发现胰腺区域淋巴结转移。应进行胰腺切除术，在保留尽可能多的胰腺组织的同时，以足够的切缘切除肿瘤。结合文献复习讨论了肾细胞癌胰腺转移的预后。这些病例也应考虑辅助化疗和内分泌治疗。
