A Case of Laparoscopic Distal Pancreatectomy for Metachoronous Pancreatic Metastasis from Renal Cell Carcinoma

Abstract

An 81-year-old man with moderate obstructive pulmonary impairment as co-morbid was diagnosed as having an about 20 mm tumor of the pancreatic body on an abdominal CT scan. Previous histories included right nephrectomy with interferon therapy for renal cell carcinoma, followed by right pulmonary partial resection for lung metastasis which occurred 2 years after the nephrectomy. This time, when 5 years had elapsed after the nephrectomy, the tumor located in the pancreas body was found by a follow-up CT scan. The tumor was diagnosed as pancreatic metastasis from the previously resected renal cancer because of the similarity of CT-enhanced pattern of the pancreatic tumor to the resected renal one. Other organ metastases were absent. Therefore, we performed laparoscopic distal pancreatectomy. Microscopically, the tumor was diagnosed as clear cell carcinoma which was identical to the previously resected renal tumor. He was discharged on 10th postoperative day without morbidities and is alive without recurrence as of 3 years after the third operation. Pancreatic metastasis of renal cell carcinoma occurs late in many cases, and surgical resection is reported to improve the long-term outcome. Laparoscopic approach that can provide radical therapy may be useful for elderly patients with pancreatic metastasis from renal cancer whose pulmonary function is deteriorated.