Skip to main content
Top
Published in: Annals of Surgical Oncology 12/2014

01-11-2014 | Pancreatic Tumors

Long-term Survival After Pancreatic Resection for Renal Cell Carcinoma Metastasis

Authors: L. Schwarz, A. Sauvanet, N. Regenet, J. Y. Mabrut, J. F. Gigot, E. Housseau, B. Millat, M. Ouaissi, B. Gayet, D. Fuks, J. J. Tuech, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2014

Login to get access

Abstract

Background

Surgical resection of pancreatic metastasis (PM) is the only reported curative treatment for renal cell carcinoma. However, there is currently little information regarding very long-term survival. The primary objective of this study was to determine the 10-year survival of this condition using the largest surgical series reported to date.

Methods

Between May 1987 and June 2003, we conducted a retrospective study of 62 patients surgically treated for PM from renal cell carcinoma at 12 Franco-Belgian surgical centers. Follow-up ended on May 31, 2012.

Results

There were 27 male (44 %) and 35 female (56 %) patients with a median age of 54 years [31–75]. Mean disease-free interval from resection of primary tumor to reoperation for pancreatic recurrence was 9.8 years (median 10 years [0–25]). During a median follow-up of 91 months [12–250], 37 recurrences (60 %) were observed. After surgical resection of repeated recurrences, overall median survival time was 52.6 months versus 11.2 months after nonoperative management (p = 0.019). Cumulative 3-, 5-, and 10-year overall survival (OS) rates were 72, 63, and 32 %, respectively. The corresponding disease-free survival rates were 54, 35, and 27 %, respectively. Lymph node involvement and existence of extrapancreatic metastases before PM were associated with poor overall survival.

Conclusions

Aggressive surgical management of single or multiple PM, even in cases of extrapancreatic disease, should be considered in selected patients to allow a chance of long-term survival.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cancer I-IAfRo. GLOBOCAN 2012: estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. 2012. Cancer I-IAfRo. GLOBOCAN 2012: estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. 2012.
2.
go back to reference Cindolo L, Patard JJ, Chiodini P, et al. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer. 2005;104(7):1362–71.PubMedCrossRef Cindolo L, Patard JJ, Chiodini P, et al. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer. 2005;104(7):1362–71.PubMedCrossRef
3.
go back to reference Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166(1):63–7.PubMedCrossRef Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166(1):63–7.PubMedCrossRef
4.
go back to reference Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003;97(7):1663–71.PubMedCrossRef Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003;97(7):1663–71.PubMedCrossRef
5.
go back to reference Brookman-May SD, May M, Shariat SF, et al. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma–results from a comprehensive multi-centre database (CORONA/SATURN-Project). BJU Int. 2013;112(7):909–16.PubMed Brookman-May SD, May M, Shariat SF, et al. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma–results from a comprehensive multi-centre database (CORONA/SATURN-Project). BJU Int. 2013;112(7):909–16.PubMed
6.
go back to reference McDermott DF, Regan MM, Clark JI, et al. Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol. 2005;23(1):133–41.PubMedCrossRef McDermott DF, Regan MM, Clark JI, et al. Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol. 2005;23(1):133–41.PubMedCrossRef
7.
go back to reference Negrier S, Escudier B, Lasset C, et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d’Immunotherapie. N Engl J Med. 1998;338(18):1272–8.PubMedCrossRef Negrier S, Escudier B, Lasset C, et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d’Immunotherapie. N Engl J Med. 1998;338(18):1272–8.PubMedCrossRef
8.
go back to reference Escudier B, Bellmunt J, Negrier S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol. 2010;28(13):2144–50.PubMedCrossRef Escudier B, Bellmunt J, Negrier S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol. 2010;28(13):2144–50.PubMedCrossRef
9.
go back to reference Rini BI, Halabi S, Rosenberg JE, et al. Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol. 2008;26(33):5422–8.PubMedCrossRefPubMedCentral Rini BI, Halabi S, Rosenberg JE, et al. Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol. 2008;26(33):5422–8.PubMedCrossRefPubMedCentral
10.
go back to reference Kavolius JP, Mastorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998;16(6):2261–6.PubMed Kavolius JP, Mastorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998;16(6):2261–6.PubMed
11.
go back to reference Kierney PC, van Heerden JA, Segura JW, Weaver AL. Surgeon’s role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review. Ann Surg Oncol. 1994;1(4):345–52.PubMedCrossRef Kierney PC, van Heerden JA, Segura JW, Weaver AL. Surgeon’s role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review. Ann Surg Oncol. 1994;1(4):345–52.PubMedCrossRef
12.
go back to reference Sohn TA, Yeo CJ, Cameron JL, Nakeeb A, Lillemoe KD. Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg. 2001;5(4):346–51.PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL, Nakeeb A, Lillemoe KD. Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg. 2001;5(4):346–51.PubMedCrossRef
13.
go back to reference Tanis PJ, van der Gaag NA, Busch OR, van Gulik TM, Gouma DJ. Systematic review of pancreatic surgery for metastatic renal cell carcinoma. Br J Surg. 2009;96(6):579–92.PubMedCrossRef Tanis PJ, van der Gaag NA, Busch OR, van Gulik TM, Gouma DJ. Systematic review of pancreatic surgery for metastatic renal cell carcinoma. Br J Surg. 2009;96(6):579–92.PubMedCrossRef
14.
go back to reference Bassi C, Butturini G, Falconi M, Sargenti M, Mantovani W, Pederzoli P. High recurrence rate after atypical resection for pancreatic metastases from renal cell carcinoma. Br J Surg. 2003;90(5):555–9.PubMedCrossRef Bassi C, Butturini G, Falconi M, Sargenti M, Mantovani W, Pederzoli P. High recurrence rate after atypical resection for pancreatic metastases from renal cell carcinoma. Br J Surg. 2003;90(5):555–9.PubMedCrossRef
15.
go back to reference Sellner F, Tykalsky N, De Santis M, Pont J, Klimpfinger M. Solitary and multiple isolated metastases of clear cell renal carcinoma to the pancreas: an indication for pancreatic surgery. Ann Surg Oncol. 2006;13(1):75–85.PubMedCrossRef Sellner F, Tykalsky N, De Santis M, Pont J, Klimpfinger M. Solitary and multiple isolated metastases of clear cell renal carcinoma to the pancreas: an indication for pancreatic surgery. Ann Surg Oncol. 2006;13(1):75–85.PubMedCrossRef
16.
go back to reference Thompson LD, Heffess CS. Renal cell carcinoma to the pancreas in surgical pathology material. Cancer. 2000;89(5):1076–88.PubMedCrossRef Thompson LD, Heffess CS. Renal cell carcinoma to the pancreas in surgical pathology material. Cancer. 2000;89(5):1076–88.PubMedCrossRef
17.
go back to reference Demirjian AN, Vollmer CM, McDermott DF, Mullen JT, Atkins MB, Callery MP. Refining indications for contemporary surgical treatment of renal cell carcinoma metastatic to the pancreas. HPB. 2009;11(2):150–3.PubMedCrossRefPubMedCentral Demirjian AN, Vollmer CM, McDermott DF, Mullen JT, Atkins MB, Callery MP. Refining indications for contemporary surgical treatment of renal cell carcinoma metastatic to the pancreas. HPB. 2009;11(2):150–3.PubMedCrossRefPubMedCentral
18.
go back to reference Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999;17(8):2530–40.PubMed Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999;17(8):2530–40.PubMed
19.
go back to reference Miller K. Renal cell carcinoma. Guidelines for diagnosis and treatment. Urol Int. 1999;63(1):6–9.PubMedCrossRef Miller K. Renal cell carcinoma. Guidelines for diagnosis and treatment. Urol Int. 1999;63(1):6–9.PubMedCrossRef
20.
go back to reference Zerbi A, Ortolano E, Balzano G, Borri A, Beneduce AA, Di Carlo V. Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection? Ann Surg Oncol. 2008;15(4):1161–8.PubMedCrossRef Zerbi A, Ortolano E, Balzano G, Borri A, Beneduce AA, Di Carlo V. Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection? Ann Surg Oncol. 2008;15(4):1161–8.PubMedCrossRef
21.
go back to reference Z’Graggen K, Fernandez-del Castillo C, Rattner DW, Sigala H, Warshaw AL. Metastases to the pancreas and their surgical extirpation. Arch Surg. 1998;133(4):413-7; discussion 418–9. Z’Graggen K, Fernandez-del Castillo C, Rattner DW, Sigala H, Warshaw AL. Metastases to the pancreas and their surgical extirpation. Arch Surg. 1998;133(4):413-7; discussion 418–9.
22.
go back to reference Escudier B, Pluzanska A, Koralewski P, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet. 2007;370(9605):2103–11.PubMedCrossRef Escudier B, Pluzanska A, Koralewski P, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet. 2007;370(9605):2103–11.PubMedCrossRef
23.
go back to reference Escudier B, Szczylik C, Hutson TE, et al. Randomized phase II trial of first-line treatment with sorafenib versus interferon Alfa-2a in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(8):1280–9.PubMedCrossRef Escudier B, Szczylik C, Hutson TE, et al. Randomized phase II trial of first-line treatment with sorafenib versus interferon Alfa-2a in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(8):1280–9.PubMedCrossRef
24.
go back to reference Motzer RJ, Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(22):3584–90.PubMedCrossRefPubMedCentral Motzer RJ, Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(22):3584–90.PubMedCrossRefPubMedCentral
25.
go back to reference Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271–81.PubMedCrossRef Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271–81.PubMedCrossRef
26.
27.
28.
go back to reference Molina AM, Lin X, Korytowsky B, et al. Sunitinib objective response in metastatic renal cell carcinoma: analysis of 1059 patients treated on clinical trials. Eur J Cancer. 2014;50(2):351–8.PubMedCrossRef Molina AM, Lin X, Korytowsky B, et al. Sunitinib objective response in metastatic renal cell carcinoma: analysis of 1059 patients treated on clinical trials. Eur J Cancer. 2014;50(2):351–8.PubMedCrossRef
29.
go back to reference Kanzaki R, Higashiyama M, Fujiwara A, et al. Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience. Eur J Cardiothor Surg. 2011;39(2):167–72.CrossRef Kanzaki R, Higashiyama M, Fujiwara A, et al. Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience. Eur J Cardiothor Surg. 2011;39(2):167–72.CrossRef
30.
go back to reference van der Poel HG, Roukema JA, Horenblas S, van Geel AN, Debruyne FM. Metastasectomy in renal cell carcinoma: a multicenter retrospective analysis. Eur Urol. 1999;35(3):197–203.PubMedCrossRef van der Poel HG, Roukema JA, Horenblas S, van Geel AN, Debruyne FM. Metastasectomy in renal cell carcinoma: a multicenter retrospective analysis. Eur Urol. 1999;35(3):197–203.PubMedCrossRef
31.
go back to reference Kwak C, Park YH, Jeong CW, Lee SE, Ku JH. Metastasectomy without systemic therapy in metastatic renal cell carcinoma: comparison with conservative treatment. Urol Int. 2007;79(2):145–51.PubMedCrossRef Kwak C, Park YH, Jeong CW, Lee SE, Ku JH. Metastasectomy without systemic therapy in metastatic renal cell carcinoma: comparison with conservative treatment. Urol Int. 2007;79(2):145–51.PubMedCrossRef
32.
go back to reference Kyoda Y, Kobayashi K, Hirobe M, et al. Evaluation of long-term outcome for patients with renal cell carcinoma after surgery: analysis of cancer deaths occurring more than 10 years after initial treatment. Int J Clin Oncol. 2013;19(1):146–51.PubMedCrossRef Kyoda Y, Kobayashi K, Hirobe M, et al. Evaluation of long-term outcome for patients with renal cell carcinoma after surgery: analysis of cancer deaths occurring more than 10 years after initial treatment. Int J Clin Oncol. 2013;19(1):146–51.PubMedCrossRef
33.
go back to reference Vogl UM, Zehetgruber H, Dominkus M, et al. Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable. Br J Cancer. 2006;95(6):691–8.PubMedCrossRefPubMedCentral Vogl UM, Zehetgruber H, Dominkus M, et al. Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable. Br J Cancer. 2006;95(6):691–8.PubMedCrossRefPubMedCentral
34.
go back to reference Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115–24.PubMedCrossRef Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115–24.PubMedCrossRef
35.
go back to reference Faure JP, Tuech JJ, Richer JP, Pessaux P, Arnaud JP, Carretier M. Pancreatic metastasis of renal cell carcinoma: presentation, treatment and survival. J Urol. 2001;165(1):20–2.PubMedCrossRef Faure JP, Tuech JJ, Richer JP, Pessaux P, Arnaud JP, Carretier M. Pancreatic metastasis of renal cell carcinoma: presentation, treatment and survival. J Urol. 2001;165(1):20–2.PubMedCrossRef
36.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
37.
go back to reference Wente MN, Kleeff J, Esposito I, et al. Renal cancer cell metastasis into the pancreas: a single-center experience and overview of the literature. Pancreas. 2005;30(3):218–22.PubMedCrossRef Wente MN, Kleeff J, Esposito I, et al. Renal cancer cell metastasis into the pancreas: a single-center experience and overview of the literature. Pancreas. 2005;30(3):218–22.PubMedCrossRef
38.
go back to reference Law CH, Wei AC, Hanna SS, et al. Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol. 2003;10(8):922–6.PubMedCrossRef Law CH, Wei AC, Hanna SS, et al. Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol. 2003;10(8):922–6.PubMedCrossRef
40.
go back to reference Masetti M, Zanini N, Martuzzi F, et al. Analysis of prognostic factors in metastatic tumors of the pancreas: a single-center experience and review of the literature. Pancreas. 2010;39(2):135–43.PubMedCrossRef Masetti M, Zanini N, Martuzzi F, et al. Analysis of prognostic factors in metastatic tumors of the pancreas: a single-center experience and review of the literature. Pancreas. 2010;39(2):135–43.PubMedCrossRef
41.
go back to reference Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol. 2006;24(19):3101–6.PubMedCrossRef Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol. 2006;24(19):3101–6.PubMedCrossRef
43.
go back to reference Sciarra A, Cattarino S, Salciccia S, et al. The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach? Crit Rev Oncol Hematol. 2012;81(2):151–62.PubMedCrossRef Sciarra A, Cattarino S, Salciccia S, et al. The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach? Crit Rev Oncol Hematol. 2012;81(2):151–62.PubMedCrossRef
Metadata
Title
Long-term Survival After Pancreatic Resection for Renal Cell Carcinoma Metastasis
Authors
L. Schwarz
A. Sauvanet
N. Regenet
J. Y. Mabrut
J. F. Gigot
E. Housseau
B. Millat
M. Ouaissi
B. Gayet
D. Fuks
J. J. Tuech, MD, PhD
Publication date
01-11-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3821-4

Other articles of this Issue 12/2014

Annals of Surgical Oncology 12/2014 Go to the issue