Metastasis to the pancreas--an indication for pancreatic resection?

Isolated metastatic involvement of the pancreas is very rare. To evaluate the possible benefit of surgery, we retrospectively analyzed patients that underwent pancreatic resection for metastases into the pancreas.

In 12 patients (8 men and 4 women), metastatic disease was treated by pancreatic resection (two total pancreatectomies, nine pylorus-sparing duodenopancreatectomies, and one left-side pancreatic resection) between 1993 and 2005 at our institution. Primary malignomas were renal cell carcinoma (RCC; n = 7), malignant melanoma (n = 4), and colon cancer (n = 1). All patients were followed-up until November 2006 or until death.

Complications requiring relaparotomy were found in two patients (retroperitoneal abscess and bile fistula), whereas one patient with pancreatic fistula could be treated by conservative measures. There was no perioperative mortality. Median survival time was 51 months (5-105 months). At the end of follow-up, seven patients were alive at 12 to 86 months, whereas five died between 5 and 105 months: four died of the disease, and one patient died of cardiac failure without evidence of recurrent cancer.

Patients with isolated pancreatic metastasis particularly of RCC benefit from surgery. Pancreatic resection may achieve long-term survival or good palliation in selected cases of other primaries as well.