Pancreatic Resection of Isolated Metastases from Nonpancreatic Primary Cancers
Tóm tắt
The goal of this study is to report the safety and efficacy of pancreatic resection for isolated metastatic cancers from nonpancreatic primary disease. We retrospectively identified patients from a single institution’s prospectively gathered pancreaticobiliary database from 1970 to 2007 who underwent a pancreatic resection for metastatic disease. Forty-nine patients were identified with metastatic lesions to the pancreas. Pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 31, 14, and 4 patients, respectively. Pathology distribution was as follows: 21 renal cell carcinoma (RCC), 6 gallbladder cancer, 4 lung cancer, 4 ovarian cancer, 4 sarcoma, 3 melanoma, 2 colon cancer, 1 breast cancer, 1 hepatocellular carcinoma, 1 seminoma, 1 Langerhans cell histiocytosis, and 1 nonpancreatic endocrine cancer. Postoperative morbidity was 48%. There were no perioperative deaths. A statistically significant difference in survival was found between cancer types (P = .007) with median survivals ranging from 4.8 years for RCC to .9 years for melanoma. Univariate analysis demonstrated a survival disadvantage for patients with perineural (hazard ratio [HR] = 5.4, P = .004) and vascular invasion (HR = 4.4, P = .002). The most commonly resected metastatic lesion of the pancreas was RCC. Eighteen of the 23 patients with RCC had a metachronous lesion with a median length between initial operation and pancreatic resection of 9.3 years. Metachronous lesions had a survival similar to that of synchronous lesions (HR = 1.0, P = .98). Vascular invasion (HR = 2.4, P = .007) and lymph node metastases (HR = 24.1, P = .01) were associated with greater mortality. Long-term survival can be achieved in patients undergoing resection of isolated metastases to the pancreas.
Tài liệu tham khảo
Roland CF, van Heerden JA. Nonpancreatic primary tumors with metastasis to the pancreas. Surg Gynecol Obstet 1989; 168:345–7.
Stankard CE, Karl RC. The treatment of isolated pancreatic metastases from renal cell carcinoma: a surgical review. Am J Gastroenterol 1992; 87:1658–60.
Z’graggen K, Fernandez-del CC, Rattner DW et al. Metastases to the pancreas and their surgical extirpation. Arch Surg 1998; 133:413–7.
Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389–94.
McCormack PM, Bains MS, Beattie EJ Jr et al. Pulmonary resection in metastatic carcinoma. Chest 1978;73:163–6.
Lee WS, Yun HR, Yun SH et al. Treatment outcomes of hepatic and pulmonary metastases from colorectal carcinoma. J Gastroenterol Hepatol 2008;23(8 Pt 2):e367–72.
Noguchi S, Miyauchi K, Nishizawa Y et al. Results of surgical treatment for sternal metastasis of breast cancer. Cancer 1988;62:1397–401.
Jett JR, Hollinger CG, Zinsmeister AR et al. Pulmonary resection of metastatic renal cell carcinoma. Chest 1983;84:442–5.
Zhu J, Wang Y, Hou M et al. Imatinib mesylate treatment for advanced gastrointestinal stromal tumor: a pilot study focusing on patients experiencing sole liver metastasis after a prior radical resection. Oncology 2008;73:324–7.
Gliedman ML, Horowitz S, Lewis FJ. Lung resection for metastatic cancer; 29 cases from the University of Minnesota and a collected review of 264 cases. Surgery 1957;42:521–32.
Pawlik TM, Vauthey JN, Abdalla EK et al. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg 2006;141:537–43.
Winter JM, Cameron JL, Campbell KA et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10:1199–210.
Bahra M, Jacob D, Langrehr JM et al. Metastatic lesions to the pancreas: when is resection reasonable? Chirurg 2008;79:241–8.
Crippa S, Angelini C, Mussi C et al. Surgical treatment of metastatic tumors to the pancreas: a single center experience and review of the literature. World J Surg 2006;30:1536–42.
Sperti C, Pasquali C, Liessi G et al. Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol 2003;83:161–6.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205–13.
Social Security death index (SSDI). Search performed July 24, 2007. Available at: http://ssdi.rootsweb.ancestry.com/
Sohn TA, Yeo CJ, Cameron JL et al. Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg 2001;5:346–51.
Hiotis SP, Klimstra DS, Conlon KC et al. Results after pancreatic resection for metastatic lesions. Ann Surg Oncol 2002;9:675–9.
Kassabian A, Stein J, Jabbour N et al. Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 2000;56:211–5.
Ghavamian R, Klein KA, Stephens DH et al. Renal cell carcinoma metastatic to the pancreas: clinical and radiological features. Mayo Clin Proc 2000;75:581–5.
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.
Law CH, Wei AC, Hanna SS et al. Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol 2003;10:922–6.
Motzer RJ, Bacik J, Schwartz LH et al. Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 2004;22:454–63.
Fegiz G, Bezzi M, De AR et al. Surgical treatment of liver metastases from colorectal cancer. Ital J Surg Sci 1985;15:259–65.
Yukawa N, Akaike M, Sugimasa Y et al. Therapeutic strategy for hepatic metastasis of primary colon cancer. Gan To Kagaku Ryoho 2001;28:1565–8.
Hananel N, Garzon J, Gordon PH. Hepatic resection for colorectal liver metastases. Am Surg 1995;61:444–7.
Sugihara K, Hojo K, Moriya Y et al. Pattern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993;80:1032–5.
Olak J, Wexler MJ, Rodriguez J et al. Hepatic resection for metastatic disease. Can J Surg 1986;29:435–9.
Okuyama K, Isono K, Satoh H et al. Basic and clinical studies on metastatic cancer—with special reference of multidisciplinary treatment of gastric and colorectal cancer patients with hepatic metastasis. Nippon Geka Gakkai Zasshi 1983;84:796–9.