Metastases to the pancreas: the experience of a high volume center and a review of the literature.

BACKGROUND: Metastasis to the pancreas (PM) is uncommon. Several types of cancers were reported to metastasize to the pancreas. Surgery is advocated in selected patients when technically feasible and if the patient can be rendered disease free. METHODS: A retrospective review of PM patients at the University of Cincinnati Pancreas Database was performed over a 7-year time period. RESULTS: Twenty patients with a median age of 62.5 years were identified. Fifteen patients (75%) were males and (50%) presented with abdominal pain. Nine patients (45.0%) were offered surgical resection, distal pancreatectomy was the most common procedure (n = 4, 44.4%). The commonest pathology was RCC (60%), followed by lung (20%), colon (15%), and breast (5%). Median disease free interval (DFI) was 96 months for RCC, 7 months for other pathologies. Median survival was 19 months for RCC, 8.5 months for other pathologies. Based on DFI, short DFI patients (≤12 months) had worse prognosis (2-year survival of 40%), as opposed to (2-year survival of 80%) in longer DFI patients (P = 0.01). RCC patients with a DFI longer than 94 months had a better survival (P = 0.01). Survival of resected PM tended to be longer than non-resected PM (P = 0.11). CONCLUSIONS: PM from RCC carries a consistently favorable prognosis compared to other pathologies. Surgical resection of PM is a safe and viable option, and, in selected patients, may improve survival. However, a period of expectant management in patients with short DFI may be considered.