Ann Hepatobiliary Pancreat Surg.  2017 May;21(2):96-100. 10.14701/ahbps.2017.21.2.96.

Laparoscopic total pancreatectomy for multiple metastasis of renal cell carcinoma of the pancreas: a case report and literature review

• Choi YJ
• Lee JH
• Lee CR
• Han WK
• Kang CM
• Lee WJ

• KMID: 2379109
• DOI: http://doi.org/10.14701/ahbps.2017.21.2.96

Abstract

Advances in surgical techniques and laparoscopic instruments have resulted in the development of laparoscopic pancreatic surgery. Total pancreaticoduodenectomy is performed for treating benign and borderline pancreatic disease involving the whole pancreas. Here, we report a case of metastatic renal cell carcinoma in the pancreas, treated by laparoscopic pylorus-preserving total pancreaticoduodenectomy. A 59-year-old woman was diagnosed with metastatic renal cell carcinoma. Multiple metastatic lesions were found on routine follow-up. She had a history of radical video-assisted right-nephrectomy for renal cell carcinoma (conventional type, pT1) in November 2003, without any recurrence. However, in 2014, a routine health checkup revealed multiple enhancing lesions throughout the pancreas. Positron emission tomography showed a suspicious 4-cm lesion in her left thyroid. Laparoscopic pylorus-preserving total pancreaticoduodenectomy with splenectomy was performed, along with simultaneous left total thyroidectomy with central compartment node dissection for metastatic renal cell carcinomas. The total operation time was 441 min, with an estimated blood loss of 150 ml; no transfusion was administered. Her hospital stay was 12 days. The histopath report confirmed metastatic renal cell carcinoma in the pancreas and left thyroid. Based on literature reviews, we further tried to estimate the oncologic outcome of total pancreatectomy in multiple pancreatic metastasis of renal cell carcinoma. Laparoscopic pylorus-preserving total pancreaticoduodenectomy is feasible and safe, even in cases of metastatic renal cell carcinoma.

Keyword

Renal cell carcinoma; Pancreas metastasis; Pancreatectomy; Laparoscopic; Survival

MeSH Terms

Carcinoma, Renal Cell*
Female
Follow-Up Studies
Humans
Length of Stay
Middle Aged
Neoplasm Metastasis*
Pancreas*
Pancreatectomy*
Pancreatic Diseases
Pancreaticoduodenectomy
Positron-Emission Tomography
Recurrence
Splenectomy
Thyroid Gland
Thyroidectomy

Figure

• 

  Fig. 1 Preoperative computed tomography scans and microscopy images of a metastatic renal cell carcinoma (RCC) in the pancreas and thyroid. Multiple, variable-sized (range, 0.7 cm-2 cm) contrast-enhancing nodules are visible in the pancreas head (A), body and tail (B). An 18-F fluorodeoxyglucose (FDG) positron emission tomography scan shows mild FDG uptake in the left thyroid (C), and a neck ultrasonography scan reveals an approximately 4-cm solid hypoechoic mass in the left thyroid gland (D). Metastatic RCC was confirmed in the pancreas (E-1), and thyroid (E-2). Note the characteristic appearance of RCC with clear cytoplasm arranged in nests (E-3). T, tumor; Pan, pancreas; Thy, thyroid.

• 

  Fig. 2 Literature review-based oncologic outcomes of total pancreatectomy for metastatic renal cell carcinoma, showing overall disease-specific survival (A), and long-term oncologic outcomes according to time interval (10 years) (B), metastasis pattern (C), and maximum tumor size (D).

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