Laparoscopic pancreatic enucleation of a clear cell renal cell carcinoma metastasis

Abstract

Authors present the case of a laparoscopic pancreatic enucleation of a clear cell renal cell carcinoma metastatic lesion of the uncinate process. A 43-year old female patient was admitted with a lesion in the uncinate process detected by abdominal ultrasound performed for mild epigastric pain she has been suffering from for 3 months prior to admission. Her past medical history is significant for right nephrectomy performed 9 years ago for clear cell renal cell carcinoma, which was confirmed by the histopathology report. A multidisciplinary investigation was performed. Pancreatic protocol CT-scan revealed a 2 cm hyper-enhancing round-shaped tumor, located within the uncinate process. Considering the CT-scan characteristics of the lesion and the past medical history of the patient, a clear cell renal cell metastasis was suspected. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) was performed. Immunohistochemical examination using CD10 confirmed the suspicion. A laparoscopic pancreatic enucleation was planned with possible Whipple procedure in case the enucleation would turn out to be unfeasible due to such factors as intensive bleeding from an intrapancreatic vessel, unclear borders of the tumor, and high risk of postoperative pancreatic fistula formation. Nevertheless the attempt to perform enucleation succeeded. The postoperative course was uneventful. The drain was removed on postoperative day 3 after amylase level control. Final histopathological examination revealed a clear cell renal cell carcinoma (RCC) metastatic lesion to the pancreas with clear surgical margins. The purpose of the video is to demonstrate the feasibility of laparoscopic pancreatic enucleation, which is an organ-preserving procedure and is accompanied with better long-term results.