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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2008

01-11-2008 | Gastrointestinal Oncology

Pancreatic Resection of Isolated Metastases from Nonpancreatic Primary Cancers

Authors: Sushanth Reddy, MD, Barish H. Edil, MD, John L. Cameron, MD, Timothy M. Pawlik, MD, MPH, Joseph M. Herman, MD, Marta M. Gilson, PhD, Kurtis A. Campbell, MD, Richard D. Schulick, MD, Nita Ahuja, MD, Christopher L. Wolfgang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2008

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Abstract

Background

The goal of this study is to report the safety and efficacy of pancreatic resection for isolated metastatic cancers from nonpancreatic primary disease.

Methods

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.

Results

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.

Conclusion

Long-term survival can be achieved in patients undergoing resection of isolated metastases to the pancreas.
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Metadata
Title
Pancreatic Resection of Isolated Metastases from Nonpancreatic Primary Cancers
Authors
Sushanth Reddy, MD
Barish H. Edil, MD
John L. Cameron, MD
Timothy M. Pawlik, MD, MPH
Joseph M. Herman, MD
Marta M. Gilson, PhD
Kurtis A. Campbell, MD
Richard D. Schulick, MD
Nita Ahuja, MD
Christopher L. Wolfgang, MD, PhD
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-0140-7

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