Long-term Outcomes After Surgical Resection of Pancreatic Metastases from Renal Clear-Cell Carcinoma

Published on Feb 11, 2021in Annals of Surgical Oncology4.061
· DOI :10.1245/S10434-021-09649-W
Giuseppe Malleo43
Estimated H-index: 43
(University of Verona),
Roberto Salvia52
Estimated H-index: 52
(University of Verona)
+ 10 AuthorsGiovanni Butturini51
Estimated H-index: 51
(University of Verona)
BACKGROUND Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival. METHODS This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up. RESULTS The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%. CONCLUSION In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.
#1Noah A. Schuster (VUmc: VU University Medical Center)H-Index: 2
#2Emiel O. Hoogendijk (VUmc: VU University Medical Center)H-Index: 25
Last. Martijn W. Heymans (VUmc: VU University Medical Center)H-Index: 66
view all 5 authors...
Abstract Objective Competing events are often ignored in epidemiological studies. Conventional methods for the analysis of survival data assume independent or non-informative censoring, which is violated when subjects that experience a competing event are censored. Because many survival studies do not apply competing risk analysis, we explain and illustrate in a non-mathematical way how to analyse and interpret survival data in the presence of competing events. Study Design and Setting Using dat...
23 CitationsSource
#1Gregorio Di Franco (UniPi: University of Pisa)H-Index: 13
#2Desirée Gianardi (UniPi: University of Pisa)H-Index: 6
Last. Luca Morelli (UniPi: University of Pisa)H-Index: 21
view all 13 authors...
Abstract Background Literature data about pancreatic resections for metastases are limited to small series, so that the role of surgery in this setting remains unclear. We herein report our experience from a tertiary care center, analyzing the outcomes of patients who underwent pancreatic resections for metastases and discussing the role of surgical resection in their management. Materials and methods From January 1999 to January 2019, 26 patients underwent pancreatic resections for metastases f...
8 CitationsSource
#1Nirmish SinglaH-Index: 18
#2Zhiqun Xie (UTSW: University of Texas Southwestern Medical Center)H-Index: 8
Last. James BrugarolasH-Index: 46
view all 21 authors...
Renal cell carcinoma (RCC) is characterized by a particularly broad metastatic swath, and, enigmatically, when the pancreas is a destination, the disease is associated with improved survival. Intrigued by this observation, we sought to characterize the clinical behavior, therapeutic implications, and underlying biology. While pancreatic metastases (PM) are infrequent, we identified 31 patients across 2 institutional cohorts and show that improved survival is independent of established prognostic...
23 CitationsSource
#1Isabel Jaén-Torrejimeno (University of Extremadura)H-Index: 2
#2Adela Rojas-Holguín (University of Extremadura)H-Index: 2
Last. Gerardo Blanco-Fernández (University of Extremadura)H-Index: 3
view all 5 authors...
Abstract Background Renal cell carcinoma (RCC) can lead to secondary pancreatic tumors even years after nephrectomy was performed. Surgical resection in selected patients shows appropriate survival rates. Methods A systematic review was performed following PRISMA guidelines. This review finished in May 2019 and included patients with resected pancreatic metastasis(es). The main purpose was to evaluate the results of surgical resection of pancreatic tumors secondary to kidney cancer. Results Afte...
5 CitationsSource
#1Börje Ljungberg (Umeå University)H-Index: 70
#2Laurance Albiges (Université Paris-Saclay)H-Index: 1
Last. Axel Bex (Royal Free London NHS Foundation Trust)H-Index: 54
view all 19 authors...
Abstract Context The European Association of Urology Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC. Objective To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable. Evidence acquisition For the 2019 update, evidence synthesis was undertaken based on a comprehensive and structured literature assessment for new and ...
434 CitationsSource
#1Qiuyi Huang (Fudan University)H-Index: 9
#2Haiyang Zhou ('SMMU': Second Military Medical University)H-Index: 6
Last. Xianjun Yu (Fudan University)H-Index: 50
view all 14 authors...
Background Metastatic lesion to the pancreas accounts for approximately 2% of pancreatic neoplasms. There is no prospective, randomized or case-controlled study evaluating the role of pancreatic metastasectomy.
9 CitationsSource
#1Go Noguchi (YCU: Yokohama City University)H-Index: 4
#2Noboru Nakaigawa (YCU: Yokohama City University)H-Index: 26
Last. Masahiro Yao (YCU: Yokohama City University)H-Index: 48
view all 26 authors...
We investigated time-dependent changes in the relapse features of renal cell carcinoma (RCC) after curative surgery. Between 1985 and 2015, 1398 patients with RCC (1226 clear cell RCC, 89 papillary RCC, and 53 chromophobe RCC) underwent curative surgery at Yokohama City University Hospital and its affiliated hospitals. We retrospectively reviewed the clinicopathologic factors of patients with relapse after surgery. Median follow-up was 56.3 months. Recurrence occurred in 245 patients (217 clear ...
9 CitationsSource
#1Shin-Rong Lee (Yale University)H-Index: 1
#2Georgios Gemenetzis (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
Last. Matthew J. Weiss (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 48
view all 9 authors...
Purpose The goal of this study was to assess the outcomes and characteristics of patients who underwent pancreatectomy for metastatic disease to the pancreas.
12 CitationsSource
#1Giuseppe Malleo (University of Verona)H-Index: 43
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
: Although mortality rates after pancreatectomy have decreased, the incidence of postoperative morbidity remains high. The major procedure-related complications are pancreatic fistula, delayed gastric emptying, and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery defined leading complications in a standardized fashion, allowing unbiased comparison of operative results and management strategies. Risk factors for postoperative complications have been investigated ...
29 CitationsSource
#1Paolo GrassiH-Index: 12
#2Ludovic DoucetH-Index: 6
Last. Giuseppe ProcopioH-Index: 33
view all 21 authors...
Pancreatic metastases from renal cell carcinoma are uncommon and their prognostic significance is not well defined. In this analysis we evaluated the outcome of patients with pancreatic metastases treated with either targeted therapies or local treatment to the pancreas. Patients with pancreatic metastases from renal cell carcinoma treated between 1993 and 2014 were identified from 11 European centers. Clinical records were retrospectively reviewed. Kaplan-Meier method and log-rank test were use...
38 CitationsSource
Cited By3
Abstract null null Background null Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. null null null Methods null Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinic...
#1Natasha Leigh (WashU: Washington University in St. Louis)
#2William G. Hawkins (WashU: Washington University in St. Louis)H-Index: 64
#1Giuseppe Malleo (University of Verona)H-Index: 43
#2Roberto Salvia (University of Verona)H-Index: 52
Last. Giovanni ButturiniH-Index: 51
view all 4 authors...