The pancreas as a target organ for metastases: Multi-center study in Argentina

Background: The pancreas is an uncommon site for metastases, accounting for 0.25% to 5% of pancreatic tumors, so that solitary pancreatic metastases are rare. The most frequent primary tumor capable of metastasizing in the pancreas is clear cell renal carcinoma (CCRC). Surgical resection remains the best therapeutic alternative to achieve long-term survival. Our aim is to present the long-term results of a multi-center study in Argentina of pancreatic resection due to pancreatic metastases. Methods: Multi-center, retrospective report of adult patients operated for pancreatic metastases from July 2010 to December 2019, in 7 high volume Argentinian HPB surgery centers. Results: 1557 pancreatic surgeries were performed, 48 (3.1%) due to pancreatic metastases. Median age was 62±11 years, 25 (52%) male. Twenty-six distal pancreatectomies, 12 pancreatoduodenectomies, 5 total pancreatectomies, 1 central pancreatectomy and 4 tumor enucleations were performed. The most frequent primary tumor was CCRC (N=35) followed by colorectal cancer (N=4). Mean number of pancreatic lesions was 1.6±3. Twenty-two (45%) patients had complications and 5 (10%) patients required reoperation; the 90-day mortality rate was 4.2%. Mean follow-up was 80 months. The mean disease-free interval was 5.3±6 years. The disease-free and overall survival was better in patients with pancreatic metastases of clear cell renal carcinoma compared with other type of cancer. Conclusion: Despite its rarity, pancreatic metastases must be considered as a possible diagnosis in patients with a prior oncological history; surgical resection remains as the main therapeutic option.