Abstract
An 80-year-old man had previously undergone right nephrectomy for right renal cell carcinoma (RCC). Thirty-four years after surgery, abdominal ultrasonography showed a mass in the pancreatic tail. Endoscopic ultrasonography showed a well-circumscribed, approximately 10 mm, ovoid lesion in the pancreatic tail without continuity with the main pancreatic duct or invasion of the splenic artery or vein. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed, and pathological examination confirmed pancreatic metastasis of clear cell RCC. Since the metastasis was solitary, with no evidence of other organ metastases or peripancreatic lymph node enlargement, a laparoscopic spleen-preserving distal pancreatectomy with preservation of the splenic vessels (LSPDP) was performed. Although RCC can develop distant metastases many years after apparently curative resection, resection of a solitary pancreatic metastasis is associated with good long-term survival. When systematic lymph-node dissection is not required, LSPDP is a suitable approach due to its minimally invasive nature and preservation of splenic immunological function.
