Abstract
BackgroundTreatment of pancreatic metastases (PM) from renal cell carcinoma (RCC) is still an issue between surgeons and oncologists, in the era of target-therapy.MethodsData from 26 patients undergoing resection of PM and extra-PM from RCC, with R0 intention were retrospectively analysed. No one received adjuvant chemotherapy. Patients were divided into two groups; Group A comprehends 14 patients who developed synchronous (5) or methacronous (9) extra-PM. Group B comprehends 12 patients that developed PM only.ResultsNo intraoperative mortality was recorded. Complications occurred in 14 patients (53.8%), all but 2 (7.26%) were graded I and II according to Clavien-Dindo classification.Recurrences occurred in 8 patients (30.8%), of whom, 5 (62.5%) were submitted for further resections in other sites.Three-, five- and ten-year observed overall survival were respectively 88,5% [95%CI: 0,56 – 1,33], 76,9% [95%CI: 0,47 – 1,19] and 50% [95%CI: 0,20 – 1,03]. Disease-free survival was 65,4% [95%CI: 0,38 – 1,05], at 3 years, 57,7% [95%CI 0,323 – 0,952] at 5 years and 42,9% [95%CI 0,157 – 0,933], at 10 years. QoL analysis, through WHOQOL-BREF questionnaire, assessed at last available follow up revealed a mean score of 75,9 ± 11,6 on 100 points.ConclusionDespite no significant differences in survival between patients affected by Pancreatic or Extra-Pancreatic metastases, PM patients seems to show better outcome when managed surgically. mRCC patients, eligible for radical metastasectomy, tend to have long survival rates, reduced recurrence rates and good QoL.Study registrationThis paper was registered retrospectively in ClinicalTrials.gov with Identification number: NCT03670992.
Highlights
Treatment of pancreatic metastases (PM) from renal cell carcinoma (RCC) is still an issue between surgeons and oncologists, in the era of target-therapy
We report cases of twenty-six consecutive patients who underwent extended pancreatic resections for metastases from clear cell RCC in order to achieve R0 resection
Twenty-six patients were submitted to nephrectomy for RCC, PM appeared in follow-up after median 13 years after primary tumour removal [range 2–35 years], except in one case where simultaneous resection of bilateral renal cancer and distal-pancreatectomy for metastases was performed
Summary
Treatment of pancreatic metastases (PM) from renal cell carcinoma (RCC) is still an issue between surgeons and oncologists, in the era of target-therapy. Advancements in technology and surgical techniques have reduced operative risk in pancreatic surgery and allowed a more aggressive approach in patients with solitary PM from RCC. Controversies still exist regarding indications to surgical resection of metachronous and/or synchronous pancreatic multiple metastases and extra-PM from RCC [5,6,7]. In case complete surgical resection of pancreatic and/or extra pancreatic metastases was unachievable chemotherapy was indicated. To our knowledge, this is the first paper that gives special attention to patients’ QoL after surgery for clear cell carcinoma, in a such long follow-up period
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