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Results After Pancreatic Resection for Metastatic Lesions

From the Departments of Surgery (SPH, KCC, MFB) and Pathology (DSK), Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence: Address correspondence and reprint requests to: Spiros P. Hiotis, MD, PhD, NYU Department of Surgery, 550 1st Ave., NB 15 S 6, New York, NY 10016; Fax: 212-263-8640; E-mail: hiotis01{at}med.nyu.edu

Background: Unlike primary pancreatic carcinoma, isolated metastatic lesions to the pancreas are uncommon. Although the value of surgical resection is poorly documented, resection may be deemed appropriate in selected cases. The aim of this study was to review our experience with the operative management of pancreatic metastases.

Methods: Sixteen patients who underwent pancreatic resection for the treatment of metastatic disease were identified from a prospective pancreatic database. The clinical features of and results after resection were examined.

Results: Renal cell carcinoma was the most frequent primary histopathology (10 of 16; 62%). In the remaining patients, the primary histopathology was non-small-cell lung cancer (n = 3), sarcoma (n = 1), melanoma (n = 1), or transitional cell carcinoma of the bladder (n = 1). A prolonged disease-free interval (median, 7.5 years) was characteristic of most patients. Operative procedures performed included eight pancreaticoduodenectomies, seven distal pancreatectomies, and one total pancreatectomy. The operative mortality was 6%, and the morbidity was 25%. The overall 2- and 5-year actuarial survival rates were 62% and 25%, respectively. A trend toward improved survival was observed in the renal cell carcinoma patients, but this finding was not statistically significant.

Conclusions: Long-term survival after pancreatic resection for metastatic disease is achievable, and patients with primary renal cell carcinoma seem to have a more favorable prognosis. Surgical resection should thus be offered to selected patients with isolated metastatic disease to the pancreas.

Key Words: Pancreas neoplasm • Metastasis • Renal cell carcinoma • Pancreatectomy

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