Surgical management of hepato-pancreatic metastasis from renal cell carcinoma

Table 1 Descriptive cohort characteristics

Patient demographics and primary disease (RCC)
Age	63 yr (range: 44-80)
Gender: male:female	7:6
Nephrectomy: right:left	6:7
Hepatic and pancreatic metastatic disease
Total cases	14
Synchronous	3 (2 liver, 1 pancreas)
Metachronous	11
Time between nephrectomy and diagnosis of metachronous disease	57 mo (range: 4-292)
Liver	29 mo (range: 4-129)
Pancreas	80 mo (range: 10-292)
Resection of metastases
Total cases	14
Hepatic resections	7
Right hepatectomy	1 (with IVC resection)
Non-anatomical hepatectomy	6 (1 with en block diaphragmatic resection)
Pancreatic resections:	7
PD	3
TP + S	2
DP + S	2
Post-operative complications	5
Hepatic resections	1
Chylous ascites	1 (managed with parenteral nutrition)
Pancreatic resections	4
Pancreatic fistula	2 (grade B)
Fluid collection	2 (managed with radiological-guided drainage and antibiotics)
Bleeding	2 (operative management)

RCC: Renal cell carcinoma; IVC: Inferior vena cava; PD: Pancreaticoduodenectomy; TP + S: Total pancreatectomy and splenectomy; DP + S: Distal pancreatectomy and splenectomy.

Table 2 Individual case characteristics

Patient	Age, gender	Site of metastasis	Time nephrectomy to metastasis (mo)	Other metastasis pre-operatively	Operation	Post-operative complications	Follow-up (mo)	Status at last follow-up	Site of recurrence	Time from resection of metastasis to recurrence (mo)
1	50, female	Pancreas	73	Lungs (resected)	PD	Bleeding, pancreatic fistula	50	Alive, disease-free	-	-
2	61, female	Pancreas	110	-	PD	Collection	66	Alive, recurrence	Right iliac bone (radiation)	28
3	64, male	Pancreas	93	-	TP + S	-	98	Alive, recurrence	Pancreatic bed recurrence and abdominal LN (Pazopanib)	53
4	66, male	Pancreas	292	-	TP	-	4	Death from disease	Brain (radiation)	3
5	63, male	Pancreas	0	-	Laparoscopic DP + S	-	61	Alive, disease-free	Liver	17
		Liver	28		Laparoscopic non-anatomical				-	-
6	63, female	Pancreas	10	-	DP + S	Pancreatic fistula	16	Alive, recurrence	Right kidney and lung (Pazopanib)	5
7	80, female	Pancreas	26	-	PD	Bleeding, collection	3	Death, no evidence of disease	-	-
8	65, male	Liver	29	-	Non-anatomical	-	94	Death, no evidence of disease	Lungs (resected)	55
9	44, female	Liver	0	-	Non-anatomical	Chylous scites	23	Death, recurrence	Liver (Pazopanib)	6
10	70, male	Liver	4	Right kidney	Non-anatomical + right partial nephrectomy	-	33	Death, recurrence	Lung and spine (radiation and Sunitinib)	3
11	61, female	Liver	0	Right adrenal, lungs (resected)	Non-anatomical	-	36	Alive, disease-free	-	-
12	59, male	Liver	40	Adrenal (in specimen of RCC resection) Lungs	Non-anatomical + diaphragm	-	32	Alive, recurrence	Liver (Pazopanib)	10
13	65, male	Liver	129	Lungs	Right hepatectomy + IVC resection	-	26	Alive, with disease, no recurrence	-	-

RCC: Renal cell carcinoma; IVC: Inferior vena cava; PD: Pancreaticoduodenectomy; TP + S: Total pancreatectomy and splenectomy; DP + S: Distal pancreatectomy and splenectomy; LN: Lymph nodes.

Table 3 Reports on surgical management of renal cell carcinoma metastasis to the liver and pancreas

Ref.	Patient No. and site	Synchronous (n and %)	Time nephrectomy to metastasis (mo, median and range	Pre-op treatment (n and %)	Post-op treatment (n and %)	Mortality (%)	Morbidity (%)	OS (mo; median and range)	1-yr OS (%)	3-yr OS (%)	5-yr OS (%)	DFS (mo; median and range)	1-yr DFS (%)	3-yr DFS (%)	5-yr DFS (%)
Ruys et al[4]	33, liver	10 (30)	50 (7-360)	12 (36)	-	0	54.5	33 (4-224)	78	47	43	10 (1-54)	49	18	11
Hatzaras et al[5]	43, liver	9 (21)	17 (2-189)	5 (12)	25 (58)	2.3	23.3	NR	94.2	62.1	-	15.5 (3-76)	79.5	27.3	-
Staehler et al[10]	68, liver	19 (28)	-	-	54 (80)	0	20.1	142 (115-169)	-	-	62.2	-	-	-	-
Aloia et al[22]	19, liver	5 (26)	53 (9-137)	-	-	5.3	32	36 (-)	-	52	26	13 (-)	-	25	25
Langan et al[23]	10, liver	5 (50)	-	4 (40)	4 (40)	0	30	24 (3-254)	79	45	34	7.2 (-)	-	-	-
Alves et al[24]	14, liver	-	-	-	-	-	-	26 (-)	69	26	-	-	-	-	-
Karavias et al[25]	6, liver	5 (83)	-	0	2 (33)	0	-	NR	NR	NR	NR	NR	66.7	66.7	66.7
Kawata et al[26]	4, liver	2 (50)	4 (2-6)	2 (50)	4 (100)	0	-	30 (12-40)	75	37.5	NR	30 (12-30)	50	50	NR
Thelen et al[27]	31, liver	6 (19)	-	-	-	3.2	12.9	48 (-)	82.2	54.3	38.9	27 (-)	76.2	38.1	26.1
Yezhelyev et al[28]	13, liver	13 (100)	0	-	-	-	-	16 (1-34)	-	-	-	-	-	-	-
Santoni et al[6]	44, pancreas	1 (2)	-	6 (14)	-	-	-	103 (-)	-	-	-	27 (3-167)	-	-	-
Bassi et al[8]	17, pancreas	-	126 (--276)	-	-	0	47	22 (9-35)	-	-	-	16 (3-30)	-	-	-
Schwartz et al[9]	62, pancreas	2 (3)	120 (0-300)	3 (5)	-	6.4	-	-	-	72	63	26 (5-166)	-	54	35
Konstadinidis et al[29]	20, pancreas	1 (5)	104 (0-264)	-	-	-	-	104 (15-144)	-	-	61	-	-	-	-
Eidt et al[30]	7, pancreas	0	169 (108-240)	-	12 (100)	0	-	65 (5-86)	85.7	85.7	85.7	65 (5-86)	85.7	85.7	85.7
Ghavamian et al[31]	11, pancreas	0	108 (18-295)	-	-	-	-	120 (5-120)	90.9	90.9	80.8	NR	90.9	90.9	80.8
Reddy et al[32]	21, pancreas	3 (14)	112 (-)	-	-	0	-	58 (4-220)	-	-	-	-	-	-	-
Tanis et al[17]	10, pancreas	0	107 (5-228)	-	1 (10)	-	-	69 (6-69)	88.9	66.7	66.7	35 (6-69)	100	58	38.9
Zerbi et al[20]	23, pancreas	0	-	-	-	0	47.8	NR	100	88	88	44 (33-52)	-	-	-
Kassabian et al[21]	5, pancreas	0	12 (4-15)	-	-	-	-	-	-	-	67	-	-	-	-
Untch et al[33]	27, pancreas	-	-	-	-	-	-	96 (-)	-	-	-	-	-	-	-

OS: Overall survival (median and range); DFS: Disease-free survival (median and range in months); NR: Not reached; Pre- and post-op treatment: Treatment modalities before and after surgical resection of renal cell carcinoma metastasis, including chemotherapy, immunotherapy, tyrosine kinase inhibitors.