Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)
Gerardo Blanco-Fernández 1 , Constantino Fondevila-Campo 2 , Alfonso Sanjuanbenito 3 , Joan Fabregat-Prous 4 , Luís Secanella-Medayo 4 , Fernando Rotellar-Sastre 5 , Fernando Pardo-Sánchez 5 , Mikel Prieto-Calvo 6 , Héctor Marín-Ortega 6 , Santiago Sánchez-Cabús 7 , Luis Diez-Valladares 8 , Óscar Alonso-Casado 9 , Carmen González-Serrano 10 , Juan Carlos Rodríguez-Sanjuan 11 , Gabriel García-Plaza 12 , Isabel Jaén-Torrejimeno 13 , Miguel Ángel Suárez-Muñoz 14 , Antonio Becerra-Massare 15 , Paula Senra-Del Rio 16 , Elizabeth Pando 17 , Rafael López-Andújar 18 , Elena Muñoz-Forner 19 , Mario Rodriguez-López 20 , Fernando Pereira 21 , Alejandro Serrablo-Requejo 22 , Víctor Sánchez Turrión 23 , Manuel Jiménez Garrido 23 , Fernando Burdío 24 , Elena Martín-Pérez 25 , Rafael Estevan-Estevan 26 , Diego López-Guerra 13 , José Castell-Gómez 27 , Javier Salinas-Gómez 27 , José Ángel López-Baena 28 , Santiago López-Ben 29 , Lorena Solar-García 30 , Alejandro J Pérez-Alonso 31 , Luis Alberto Martínez-Insfran 32 , Juan Luis Blas 33 , Marian Cornejo 34 , Alberto Gutierrez-Calvo 35 , Carlos Domingo-Del Pozo 36 , Federico Ochando-Cerdan 37 , Luis Muñoz-Bellvís 38 , José Rebollar-Saenz 39 , Belinda Sánchez 40 , José María Jover 41 , Miguel Ángel Gómez-Bravo 42 , José M Ramia 43 , Adela Rojas-Holguín 13
Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients.
Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected.
Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01).
Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.