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Surgical Resection for Metastatic Tumors in the Pancreas: A Single-Center Experience and Systematic Review

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

Methods

The PubMed, EMBASE, and Cochrane Library electronic databases were searched for studies published between January 1, 2001 and December 31, 2017. Studies with five or more patients who received pancreatic metastasectomy and data from our institution (29 patients) were included. The Kaplan–Meier method was used for survival analysis.

Results

A total of 414 patients from 20 institutions who underwent pancreatic resections were included. Of the reported 31 kinds of primary neoplasms, renal-cell carcinoma (RCC) comprised the most (54.3%). At the time of diagnosis, although 40.3% patients were asymptomatic, abdominal pain (34.8%) and jaundice (20.6%) were relatively common. As for surgical type, pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy, and enucleation took up 37.9%, 11.4%, 43.5%, and 7.2% respectively. The mortality and morbidity rates were 1.4% and 48.3% respectively. Patients with symptoms at the time of diagnosis had significantly shorter survival compared with asymptomatic patients (p = 0.017). Those with RCC as primary tumor had significantly longer survival compared with non-RCC patients (p < 0.001). Positive margin also predicts worse prognosis (p = 0.035).

Conclusions

Pancreatic metastasectomy is safe and associated with acceptable short- and intermediate-term results. In the conditions of RCC as the primary tumor, being asymptomatic, or negative resection margin, a better prognosis after resection can be achieved.

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Acknowledgment

This work was supported by the National Science Fund for Distinguished Young Scholars [grant number 81625016].

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Author notes

  1. Qiuyi Huang, Haiyang Zhou, Chen Liu and Kaizhou Jin have contributed equally to this work.

Authors and Affiliations

  1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

    Qiuyi Huang MD, Chen Liu MD, Kaizhou Jin MD, Kun Fan MD, He Cheng MD, Zhiyao Fan MD, Chao Yang MD, Liang Liu MD, Jiang Long MD, Jin Xu MD, Quanxing Ni MD & Xianjun Yu MD

  2. Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China

    Qiuyi Huang MD, Chen Liu MD, Kaizhou Jin MD, Kun Fan MD, He Cheng MD, Zhiyao Fan MD, Chao Yang MD, Liang Liu MD, Jiang Long MD, Jin Xu MD, Quanxing Ni MD & Xianjun Yu MD

  3. Shanghai Pancreatic Cancer Institute, Shanghai, People’s Republic of China

    Qiuyi Huang MD, Chen Liu MD, Kaizhou Jin MD, Kun Fan MD, He Cheng MD, Zhiyao Fan MD, Chao Yang MD, Liang Liu MD, Jiang Long MD, Jin Xu MD, Quanxing Ni MD & Xianjun Yu MD

  4. Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China

    Haiyang Zhou MD & Zhiqian Hu MD

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Supplementary Figure 1

: Pathological diagnoses of patients. RCC renal cell carcinoma. Colorectal cancer/46: Colonic adenocarcinoma/43, Rectal cancer/3; Others: Gallbladder carcinoma/13, Breast cancer/10, Lymphoma/4, Carcinoid/4, Malignant fibrous histiocytoma/2, Medullary thyroid cancer/1, NET of the ileum/1, Hepatocellular carcinoma/1, Seminoma/1, Esophageal cancer/3, Adrenal cortical/1, Fallopian/1, Bladder cancer/2, Uterine/1, Choriocarcinoma/1, Duodenal cancer/1, Mesenteric fibromatosis/2, Hemangiopericytoma (brain)/1, Cervical cancer/1, Cholangiocarcinoma/2, Merkel cell/2, Gastrointestinal stromal tumor/2, Unknown origin/1. n = number of patients (TIFF 38 kb)

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Huang, Q., Zhou, H., Liu, C. et al. Surgical Resection for Metastatic Tumors in the Pancreas: A Single-Center Experience and Systematic Review. Ann Surg Oncol 26, 1649–1656 (2019). https://doi.org/10.1245/s10434-019-07258-2

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