Surgical resection of metastasis to the pancreas METHODS and 8 men and 3 women were included in the study. Of these 11 patients, 7 patients had been previously treated Between January 1995 and March 2009, 11 patients un- for renal cell carcinoma (RCC), 2 for a carcinoid tumor, 1 derwent pancreatic resection for a metastatic tumor to the for rectal adenocarcinoma, and 1 for leiomyosarcoma of pancreas at the Samsung Medical Center, Sungkyunkwan the lower extremity. Details of clinical findings are sum- University School of Medicine. During the same period, marized in Table 1. 1,181 pancreaticoduodenectomies, 73 total pancreatec- The median time between primary surgery and a diag- tomies and 317 distal pancreatectomies, were performed nosis of pancreatic metastasis was 51 months (range, 14 to for various pancreatic diseases. We excluded patients who 180 months). Nine patients were asymptomatic and meta- underwent pancreatic resection because of direct involve- static lesions were discovered during follow-up. The ment of the gland by other abdominal tumors. All patients symptomatic 2 patients experienced neck mass and dizzi- had a metachronous lesion and the pancreas was a site of ness 180, 118 months after nephrectomy for RCC, metastasis at the time of resection. Primary tumors were respectively. The patient with neck mass had 4.8 cm en- reviewed to confirm diagnoses and to identify possible hancing mass and the other patient had a 5.3 cm heteroge- correlations with cancer type. Standard operative proce- neously enhancing mass with an internal ill-defined dures were adopted for resectable tumors: pylorus-pre- low-density area in the pancreatic tail by computed to- serving pancreaticoduodenectomy for tumors in the head, mography (CT). Of all patients, CT scans revealed a heter- and distal pancreatosplenectomy for tumors in the body ogeneously enhancing pancreatic mass in 9 patients (7 or tail. Primary tumor histologies and treatments, times RCC and 2 carcinoid metastases) and a low density lesion between primary operations and metastasis diagnoses, in the remaining patients (rectal cancer and metastasis presenting symptoms, diagnostic tools, surgical treat- from leiomyosarcoma, respectively). ments, and perioperative morbidities and mortalities Two patients with carcinoid metastasis underwent 18- were evaluated, by conducting a retrospective review of fluorodeoxyglucose positron emission tomography (FDG medical records and by contacting patients directly. PET) and achieved a positive finding. One patient showed RESULTS another region of increased focal uptakes by 18-FDG in the pancreatic head and uncinate process, which were not de- tected by CT, but which were confirmed by endoscopic ultrasonography. Median patient age was 54 years (range, 35 to 75 years), Three patients showed evidence of concurrent ex- Table 1. Clinical findings of eleven patients with metastasis to the pancreas Patients A(ygre) Sex Diagnosis Primary treatment Intervals between primary tumor and Symptoms metastases (mo) Site No. of Extrapancreatic tumors disease 1 2 3 4 5 6 7 8 9 10 11 59 75 66 56 66 54 51 35 48 41 49 M Renal cell carcinoma Nephrectomy M Renal cell carcinoma Nephrectomy M Renal cell carcinoma Nephrectomy M Renal cell carcinoma Partial nephrectomy F Renal cell carcinoma Nephrectomy M Renal cell carcinoma Nephrectomy M Renal cell carcinoma Nephrectomy M Carcinoid tumor Thymectomy F Carcinoid tumor Right hemihepatectomy M Rectal cancer Low anterior resection F Leiomyosarcoma Wide excision 180 118 99 64 14 31 46 108 51 14 50 Neck mass Tail Multiple Dizziness Tail Solitary Asymptomatic Head Solitary Asymptomatic Body Multiple Asymptomatic Tail Solitary Asymptomatic Body Solitary Asymptomatic Head, body Solitary Asymptomatic Head, body Multiple Asymptomatic Body Solitary Asymptomatic Tail Solitary Asymptomatic Head Solitary thesurgery.or.kr Thyroid − − Local recur − − − Mediastinum − − − 279