Pancreatic metastases − diagnosis, radical surgery, complications and survival
Authors:
M. Loveček 1; P. Skalický 1; M. Kliment 3; D. Klos 2; M. Ghothim 1; R. Vrba 2; Č. Neoral 1; R. Havlík 2
Authors‘ workplace:
I. chirurgická klinika LF UP Olomouc, přednosta: prof. MUDr. Č. Neoral, CSc.
1; I. chirurgická klinika, Fakultní nemocnice Olomouc, přednosta: prof. MUDr. Č. Neoral, CSc.
2; Centrum péče o zažívací trakt, Vítkovická nemocnice Ostrava, vedoucí pracoviště: prim. MUDr. O. Urban, PhD.
3
Published in:
Rozhl. Chir., 2015, roč. 94, č. 5, s. 193-198.
Category:
Original articles
Overview
Introduction:
Although generally uncommon, pancreatic metastases are increasingly encountered in clinical practice. The benefit of pancreatic resections in this setting is unclear and still being discussed. Renal cell carcinoma is the most frequent primary tumour metastasing to the pancreas – R0 resections in cases of solitary metastases can be performed. Resections in malignant melanoma and ovarian cancer are rather considered as palliative. The aim of this study is to analyse our own set of patients operated on for metastases into the pancreas and evaluate the results of their surgical treatment.
Methods:
We identified the patients operated on for metastases to the pancreas. Patient and tumour characteristics were summarized using descriptive statistics.
Results:
A total of 9 patients (out of 312 patients undergoing resection for malignancy in the period of 2006−2014) with pancreatic metastases were analysed. All but one were asymptomatic; the symptomatic patient suffered from GI bleeding. All patients had a metachronous lesion with a median length of 12 years (4−21 years) between the initial operation and pancreatic resection. The most common metastasing tumour was renal cell carcinoma (77%) with the highest incidence occurring at the head of the pancreas (44%). The most frequent procedure used was the pylorus-preserving pancreatic head resection (44%). The median operating time was 247 min, (126−375 min). Six patients were complication free, the median of their hospital stay was 9.5 days (8−12 days). Complications included PPH type C and PF type B both of which required surgical intervention; however, PF type A required no intervention. No postoperative deaths occurred, multiple metastases were found in 4 patients with renal cell carcinoma metastases. The median of follow-up has been 11.5 months, (3−34 months).
Conclusion:
Survival after pancreatic resections due to renal cell carcinoma is favourable. Mortality is low and morbidity is similar to that associated with pancreatic resections due to other aetiologies, making surgery a valid and safe treatment option. Lifelong follow-up of patients after nephrectomy is advised. Resections in pancreatic metastases of malignant melanoma or ovarian carcinoma are considered as palliative, their indication being individual following interdisciplinary consultation.
Key words:
metastases – pancreas − resections
Sources
1. Sperti C, Moletta L, Patane G. Metastatic tumors to the pancreas: The role of surgery. World J Gastrointest Oncol 2014;6:381−92.
2. Reddy S, Edil BH, Cameron JL, et al. Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol 2008;15:3199−206.
3. Song SW, Cheng JF, Jiu N, et al. Diagnosis and treatment of pancreatic metastases in 22 patients: a retrospective study. World J of Surg Oncology 2014;12:299.
4. Reddy S, Wolfgang CL. The role of surgery in management of isolated metastases to the pancreas. Lancet Oncol 2009;10:287−93.
5. Sweeney AD, Wu MF, Hilsenbeck SG, et al. Value of pancreatic resection for cancer metastasis to the pancreas. Journal of Surgical Research 2009;156:189−98.
6. Varga M, Oliverius M, Valsamis A, et al. Resekce pankreatu pro metastázy karcinomu ledviny. Klin Onkol 2009;22:288−90.
7. Zerbi A, Ortolano E, Balzano G, et al. Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection? Ann Surg Oncol 2008;15:1161−8.
8. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931−7.
9. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: An international study group (ISGPF) definition. Surgery. 2005;138:8−13
10. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20−5.
11. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761−8.
12. www.svod.cz
13. Konstantinidis IT, Dursun A, Zheng H, et al. Metastatic tumors in the pancreas in the modern era. J Am Coll Surg 2010;211:749−53.
14. Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001;166:1611−23.
15. Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med 1996;335:865−5.
16. Le Borgne J, Partensky C, Glemain P, et al. Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors. Hepatogastroenterology 2000;47:540−4.
17. Massetti M, Zanini N, Martuzzi F, et al. Analysis of prognostic factors in metastatic tumors of the pancreas: a single-center experience and review of the literature. Pancreas 2010;39:135−43.
18. Nikfarjam M, Evans P, Christophi C. Pancreatic resection for metastastic melanoma. HPB (Oxford) 2003;5:174−9.
19. Edit S, Jergas M, Schmidt R, et al. Metastasis to the pancreas – an indication for pancreatic resection? Langenbecks Arch Surg 2007;392:539−42.
20. Goyal J, Lipson EJ, Rezaee N, et al. Surgical resection of malignant melanoma metastatic to the pancreas: case series and review of literature. J Gastrointest Cancer 2012;43:431−6.
21. Wood TF, DiFronzo LA, Rose DM, et al. Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival? Ann Surg Oncol 2001;8:658−62.
22. Sperti C, Polizi ML, Beltrame V, et al. Pancreatic resection for metastatic melanoma. Case report and review of the literature. J Gastrointest Cancer. 2011;42:302−6.
23. Yildirim Y, Sanci M. The feasibility and morbidity of distal pancreatectomy in extensive cytoreductive surgery for advanced epithelial ovarian cancer. Arch Gynecol Obstet 2005;272:31−4. Epub 2004 Oct 9.
24. Schumacher A. Delayed diagnosis of ovarian cancer with metastasis to the pancreas. Zentralbl Gynekol. 1993;115:568−9.
25. Hadzri MH, Rosemi S. Pancreatic metastases from ovarian carcinoma--diagnosis by endoscopic ultrasound-guided fine needle aspiration. Med J Malaysia 2012;67:210−1.
26. Dar FS, Mukherjee S, Bhattacharya S. Surgery for secondary tumors of the pancreas. HPB (Oxford) 2008;10:498−500.
27. Čečka F, Jon B, Šubrt Z, et al. Pankreatická píštěl – definice, rizikové faktory a možnosti léčby. Rozhl Chir 2013;92:7−84.
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Perspectives in Surgery
2015 Issue 5
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