Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID).

BACKGROUND AND OBJECTIVES: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID).

BACKGROUND: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.

Bypass biliopancreático. Comentario / Biliopancreatic bypass. Comment

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Derivación biliopancreática laparoscópica para el tratamiento de la obesidad mórbida.Aspectos técnicos y análisis de los resultadospreliminares / Laparoscopic biliopancreatic diversion for the treatment of severe obesity. Technical aspects and analysis of preliminary results

Objetivo. En el presente estudio pretendemos demostrar que la derivación biliopancreática puede ser llevada a cabo por vía laparoscópica, aunque con cierto grado de complejidad.Pacientes y método. Entre noviembre de 2000 y abril de 2003 hemos realizado una derivación biliopancreática laparoscópica a 40 pacientes afectados de obesidad mórbida, 33 mujeres y 7 varones, con una edad media de 44,8 años y un índice medio de masa corporal de 46,6 kg/m2 (rango, 39,9-61 kg/m2). En nuestra serie realizamos gastrectomía cuando existía algún factor de riesgo de enfermedad neoplásica y/o ulcerosa (positividad para Helicobacter pylori, pólipo,displasia o metaplasia). En caso contrario manteníamos el estómago distal, de forma similar al bypass gástrico. Mantuvimos el remanente gástrico distal en 29 casos y practicamos gastrectomía en 11.Resultados. El tiempo operatorio medio en los primeros 10 casos fue de 242 min (rango, 180-360 min) y 3 de ellos requirieron reconversión. En los últimos 10 pacientes el tiempo fue de 143 min (rango, 110-190 min). Entre los primeros 6 pacientes, 3 tuvieron complicaciones (fuga anastomótica, edema y estenosis de gastroyeyunostomía y un fallecimiento por broncoaspiración). En el resto de la serie hubo un caso de hemoperitoneo que no precisó intervención quirúrgica y otro de atelectasia. En el momento actual, 11 pacientes han superado los 18 meses tras la intervención, con un índice de masa corporal medio de 27,7 kg/m2 (rango, 20-31,8 kg/m2) y un porcentaje medio de sobrepeso perdido del 82,5 por ciento (rango, 61,3125 por ciento).Conclusiones. La derivación biliopancreática es factible por vía laparoscópica, pero está gravada por una dificultosa curva de apredizaje (AU)