Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2017

01-03-2017 | Pancreatic Tumors

Long-Term Outcomes of 98 Surgically Resected Metastatic Tumors in the Pancreas

Authors: Shin-Rong Lee, MD, PhD, Georgios Gemenetzis, MD, Michol Cooper, MD, PhD, Ammar A. Javed, MD, John L. Cameron, MD, Christopher L. Wolfgang, MD, PhD, Frederick E. Eckhauser, MD, Jin He, MD, PhD, Matthew J. Weiss, MD

Published in: Annals of Surgical Oncology | Issue 3/2017

Login to get access

Abstract

Purpose

The goal of this study was to assess the outcomes and characteristics of patients who underwent pancreatectomy for metastatic disease to the pancreas.

Methods

Patients who underwent surgical resection of metastatic disease to the pancreas from 1988 to 2016 were identified using a prospectively maintained database. Data on clinicopathological features and outcomes of these patients were analyzed. Cox proportional hazard models were employed to identify patient-specific risk factors that influence survival.

Results

Ninety-seven patients underwent 98 pancreatic metastasectomies from July 1988 through March 2016 for metastatic disease from 13 different primary cancers. Pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 49 (50 %), 37 (38 %), and 12 (12 %) patients, respectively. Postoperative complications occurred in 55 (56 %) patients, while 3 (3 %) perioperative deaths occurred. Median follow-up was 2.0 years, with a median survival of 3.2 years. Multivariate analysis revealed that older patients [hazard ratio (HR) 1.04/year; p = 0.006], non-renal cell carcinomas (HR 5.07; p < 0.001), vascular invasion (HR 3.53; p < 0.001), and positive resection margins (HR 2.62; p = 0.008) were independently associated with an increased risk of mortality.

Conclusions

Pancreatic metastasectomy is safe and feasible in well-selected patients and is associated with acceptable long-term survival.
Appendix
Available only for authorised users
Literature
1.
Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer. 2015;121(5):747–57.CrossRefPubMed
2.
Deutsch GB, Kirchoff DD, Faries MB. Metastasectomy for stage IV melanoma. Surg Oncol Clin N Am. 2015;24(2):279–98.CrossRefPubMed
3.
Mahmoud N, Bullard Dunn K. Metastasectomy for stage IV colorectal cancer. Dis Colon Rectum. 2010;53(7):1080–92.CrossRefPubMed
4.
Thomas AZ, Adibi M, Borregales LD, Wood CG, Karam JA. Role of metastasectomy in metastatic renal cell carcinoma. Curr Opin Urol. 2015;25(5):381–9.CrossRefPubMed
5.
Fan J, Chen D, Du H, Shen C, Che G. Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis. J Thorac Dis. 2015;7(8):1441–51.PubMedPubMedCentral
6.
Dossett LA, Toloza EM, Fontaine J, et al. Outcomes and clinical predictors of improved survival in a patients undergoing pulmonary metastasectomy for sarcoma. J Surg Oncol. 2015;112(1):103–6.CrossRefPubMed
7.
Dy BM, Que FG, Thompson GB, et al. Metastasectomy of neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. Am J Surg. 2014;208(6):1047–53; discussion 1052–1053.CrossRefPubMed
8.
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94(7):982–99.CrossRefPubMedPubMedCentral
9.
Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg. 2007;84(1):324–38.CrossRefPubMed
10.
Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.CrossRefPubMed
11.
Adler H, Redmond CE, Heneghan HM, et al. Pancreatectomy for metastatic disease: a systematic review. Eur J Surg Oncol. 2014;40(4):379–86.CrossRefPubMed
12.
Sperti C, Moletta L, Patane G. Metastatic tumors to the pancreas: the role of surgery. World J Gastrointest Oncol. 2014;6(10):381–92.PubMedPubMedCentral
13.
Nakamura E, Shimizu M, Itoh T, Manabe T. Secondary tumors of the pancreas: clinicopathological study of 103 autopsy cases of Japanese patients. Pathol Int. 2001;51(9):686–90.CrossRefPubMed
14.
Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD. Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Arch. 2004;444(6):527–35.CrossRefPubMed
15.
Tosoian JJ, Cameron JL, Allaf ME, et al. Resection of isolated renal cell carcinoma metastases of the pancreas: outcomes from the Johns Hopkins Hospital. J Gastrointest Surg. 2014;18(3):542–8.CrossRefPubMed
16.
Reddy S, Edil BH, Cameron JL, et al. Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol. 2008;15(11):3199–206.CrossRefPubMed
17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
18.
19.
Palmowski M, Hacke N, Satzl S, et al. Metastasis to the pancreas: characterization by morphology and contrast enhancement features on CT and MRI. Pancreatology. 2008;8(2):199–203.CrossRefPubMed
20.
Pang JC, Roh MH. Metastases to the pancreas encountered on endoscopic ultrasound-guided, fine-needle aspiration. Arch Pathol Lab Med. 2015;139(10):1248–52.CrossRefPubMed
21.
Smith AL, Odronic SI, Springer BS, Reynolds JP. Solid tumor metastases to the pancreas diagnosed by FNA: a single-institution experience and review of the literature. Cancer Cytopathol. 2015;123(6):347–55.CrossRefPubMed
22.
Gao G, Gong B, Shen W. Meta-analysis of the additional value of integrated 18FDG PET-CT for tumor distant metastasis staging: comparison with 18FDG PET alone and CT alone. Surg Oncol. 2013;22(3):195–200.CrossRefPubMed
23.
Hong S, Li J, Wang S. 18FDG PET-CT for diagnosis of distant metastases in breast cancer patients. A meta-analysis. Surg Oncol. 2013;22(2):139–43.CrossRefPubMed
24.
Li J, Xu W, Kong F, Sun X, Zuo X. Meta-analysis: accuracy of 18FDG PET-CT for distant metastasis staging in lung cancer patients. Surg Oncol. 2013;22(3):151–5.CrossRefPubMed
25.
He J, Ahuja N, Makary MA, et al. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB (Oxford). 2014;16(1):83–90.CrossRefPubMed
26.
Yazbek T, Gayet B. The place of enucleation and enucleo-resection in the treatment of pancreatic metastasis of renal cell carcinoma. JOP. 2012;13(4):433–8.PubMed
27.
He J, Edil BH, Cameron JL, et al. Young patients undergoing resection of pancreatic cancer fare better than their older counterparts. J Gastrointest Surg. 2013;17(2):339–44.CrossRefPubMed
28.
Di Lorenzo G, Scagliarini S, Di Napoli M, Scognamiglio F, Rizzo M, Carteni G. Targeted therapy in the treatment of metastatic renal cell cancer. Oncology. 2009;77 Suppl 1:122–31.CrossRefPubMed
29.
Coppin C, Kollmannsberger C, Le L, Porzsolt F, Wilt TJ. Targeted therapy for advanced renal cell cancer (RCC): a Cochrane systematic review of published randomised trials. BJU Int. 2011;108(10):1556–63.CrossRefPubMed
30.
Santoni M, Conti A, Partelli S, et al. Surgical resection does not improve survival in patients with renal metastases to the pancreas in the era of tyrosine kinase inhibitors. Ann Surg Oncol. 2015;22(6):2094–2100.CrossRefPubMed
31.
Yu X, Wang B, Li X, et al. The significance of metastasectomy in patients with metastatic renal cell carcinoma in the era of targeted therapy. Biomed Res Int. 2015;2015:176373.PubMedPubMedCentral
32.
Achermann C, Stenner F, Rothschild SI. Treatment, outcome and prognostic factors in renal cell carcinoma: a single center study (2000–2010). J Cancer. 2016;7(8):921–7.CrossRefPubMedPubMedCentral
33.
Kalra S, Atkinson BJ, Matrana MR, et al. Prognosis of patients with metastatic renal cell carcinoma and pancreatic metastases. BJU Int. 2016;117(5):761–5.CrossRefPubMed
34.
Grassi P, Verzoni E, Mariani L, et al. Prognostic role of pancreatic metastases from renal cell carcinoma: results from an Italian center. Clin Genitourin Cancer. 2013;11(4):484–8.CrossRefPubMed
35.
Ollila DW, Gleisner AL, Hsueh EC. Rationale for complete metastasectomy in patients with stage IV metastatic melanoma. J Surg Oncol. 2011;104(4):420–4.CrossRefPubMed
36.
Hong S-M, Goggins M, Wolfgang CL, et al. Vascular invasion in infiltrating ductal adenocarcinoma of the pancreas can mimic pancreatic intraepithelial neoplasia: a histopathologic study of 209 cases. Am J Surg Pathol. 2012;36(2):235–41.CrossRefPubMedPubMedCentral
37.
Li P, Ling Y-H, Zhu C-M, et al. Vascular invasion as an independent predictor of poor prognosis in nonmetastatic gastric cancer after curative resection. Int J Clin Exp Pathol. 2015;8(4):3910–18.PubMedPubMedCentral
38.
Belsante M, Darwish O, Youssef R, et al. Lymphovascular invasion in clear cell renal cell carcinoma–association with disease-free and cancer-specific survival. Urol Oncol. 2014;32(1):30–e23.CrossRef
39.
Fujii T, Yajima R, Morita H, et al. Impact of vascular invasion of a primary tumor as a strong risk factor for disease recurrence in patients with node-positive breast cancer. Am Surg. 2015;81(5):523–6.PubMed
40.
Murthy SC, Kim K, Rice TW, et al. Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma? Ann Thorac Surg. 2005;79(3):996–1003.CrossRefPubMed
41.
Niess H, Conrad C, Kleespies A, et al. Surgery for metastasis to the pancreas: is it safe and effective? J Surg Oncol. 2013;107(8):859–64.CrossRefPubMed
42.
Strobel O, Hackert T, Hartwig W, et al. Survival data justifies resection for pancreatic metastases. Ann Surg Oncol. 2009;16(12):3340–9.CrossRefPubMed
43.
Mekhail TM, Abou-Jawde RM, Boumerhi G, et al. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005;23(4):832–41.CrossRefPubMed
44.
Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27(34):5794–9.CrossRefPubMed
Metadata
Title
Long-Term Outcomes of 98 Surgically Resected Metastatic Tumors in the Pancreas
Authors
Shin-Rong Lee, MD, PhD
Georgios Gemenetzis, MD
Michol Cooper, MD, PhD
Ammar A. Javed, MD
John L. Cameron, MD
Christopher L. Wolfgang, MD, PhD
Frederick E. Eckhauser, MD
Jin He, MD, PhD
Matthew J. Weiss, MD
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5619-z

Other articles of this Issue 3/2017

Annals of Surgical Oncology 3/2017 Go to the issue

Gastrointestinal Oncology

Increasing the Number of Examined Lymph Nodes is a Prerequisite for Improvement in the Accurate Evaluation of Overall Survival of Node-Negative Gastric Cancer Patients

Health Services Research and Global Oncology

Influence of the SSO/ASTRO Margin Reexcision Guidelines on Costs Associated with Breast-Conserving Surgery

Gastrointestinal Oncology

Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study

Breast Oncology

The Impact of Primary Care Providers on Patient Screening Mammography and Initial Presentation in an Underserved Clinical Setting

Breast Oncology

Variation in the Types of Providers Participating in Breast Cancer Follow-Up Care: A SEER-Medicare Analysis

Breast Oncology

Ultrasound-Guided Core-Needle Versus Vacuum-Assisted Breast Biopsy: A Cost Analysis Based on the American Society of Breast Surgeons’ Mastery of Breast Surgery Registry