Multiple pancreatic metastases of renal cancer successfully treated with extended distal pancreatectomy

Abstract

The patient, a 79-year-old woman who had a total right nephrectomy for a right renal cell carcinoma in June 1994, was found to have a 20-mm tumor in the pancreatic head on ultrasound in May 2007. Given the tumor's volume the patient was admitted for surgery in June 2008. The patient had a poor surgical risk due to her advanced age, as well as the presence of an old myocardial infarction, chronic renal failure, diabetes mellitus, and cataract-induced decreased vision. Preoperative diagnostic investigations identified a 44-mm tumor in the pancreatic head and 22- and 16-mm tumors in the pancreatic body and tail, separated slightly from the gastroduodenal artery and pancreatic head arcade. Thus, later that same month, extended distal pancreatectomy and splenectomy were performed. Postoperatively, there was persistent pancreatic fluid leakage. When the patient was discharged in October, she no longer required treatment for diabetes. Surgery is generally recommended in patients with pancreatic metastases of renal cancer to improve their prognosis. The preoperative examination can guide surgery so that QOL can be maintained.