Dong Do You, et al. principle of the primary tumor when multiple metastasis was recognized. Originally, radical nephrectomy was the gold standard for RCC without metastasis. However, the increase in small renal tumors incidentally found at earlier stages has lead to organ preserving surgery which been more fre- quently preferred to radical nephrectomy for tumors less than 4 cm in diameter and limited to the kidney. For small- er tumors (＜ 2 cm in diameter), simple enucleation, dis- secting around the pseudocapsule of the tumor, can be ap- plied [15]. Similarly, we assumed that the biology of pri- mary tumor would be same as if metastasis is solitary and the size is small. Therefore, metastatic RCC to the pancreas less than 2 cm in diameter that was not close to a main pan- creatic duct can be a good indication for organ preserving pancreatectomy such as enucleation. In our series, 2 pa- tients with metastatic RCC smaller than 2 cm underwent enucleation and has been disease-free status at 7, 69 months postoperatively. However, further studies in or- gan preserving pancreatectomy for small metastatic RCC are necessary. Since our study has the limitation of small sample size, heterogeneity of the primary tumor, some combination of adjuvant therapy and retrospective design, it might be dif- ficult that surgical resection of pancreatic metastases would provide survival benefit. Additional follow up of our cohort and more experience of surgical resection for pancreatic metastasis would clarify these limits. In conclusion, patients with a low surgical risk should be considered for pancreatic metastasectomy if curative resection is possible. Careful selection of patients under- going pancreatic resection for metastatic disease should be based on the primary cancer type which is associated with survival benefit after metastasectomy. CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported. 282 REFERENCES 1. Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD. Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Arch 2004;444:527-35. 2. Crippa S, Angelini C, Mussi C, Bonardi C, Romano F, Sartori P, et al. Surgical treatment of metastatic tumors to the pancreas: a single center experience and review of the literature. World J Surg 2006;30:1536-42. 3. Z'graggen K, Fernández-del Castillo C, Rattner DW, Sigala H, Warshaw AL. Metastases to the pancreas and their sur- gical extirpation. Arch Surg 1998;133:413-7. 4. Hiotis SP, Klimstra DS, Conlon KC, Brennan MF. Results after pancreatic resection for metastatic lesions. Ann Surg Oncol 2002;9:675-9. 5. Sperti C, Pasquali C, Liessi G, Pinciroli L, Decet G, Pedrazzoli S. Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol 2003;83:161-6. 6. Law CH, Wei AC, Hanna SS, Al-Zahrani M, Taylor BR, Greig PD, et al. Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment, and outcome. Ann Surg Oncol 2003;10:922-6. 7. Reddy S, Edil BH, Cameron JL, Pawlik TM, Herman JM, Gilson MM, et al. Pancreatic resection of isolated meta- stases from nonpancreatic primary cancers. Ann Surg Oncol 2008;15:3199-206. 8. Nakeeb A, Lillemoe KD, Cameron JL. The role of pan- creaticoduodenectomy for locally recurrent or metastatic carcinoma to the periampullary region. J Am Coll Surg 1995;180:188-92. 9. Palmowski M, Hacke N, Satzl S, Klauss M, Wente MN, Neukamm M, et al. Metastasis to the pancreas: character- ization by morphology and contrast enhancement features on CT and MRI. Pancreatology 2008;8:199-203. 10. Ghavamian R, Klein KA, Stephens DH, Welch TJ, LeRoy AJ, Richardson RL, et al. Renal cell carcinoma metastatic to the pancreas: clinical and radiological features. Mayo Clin Proc 2000;75:581-5. 11. Muranaka T, Teshima K, Honda H, Nanjo T, Hanada K, Oshiumi Y. Computed tomography and histologic appear- ance of pancreatic metastases from distant sources. Acta Radiol 1989;30:615-9. 12. Hustinx R. PET imaging in assessing gastrointestinal tumors. Radiol Clin North Am 2004;42:1123-39, ix. 13. Kassabian A, Stein J, Jabbour N, Parsa K, Skinner D, Parekh D, et al. Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 2000;56:211-5. 14. Reddy S, Wolfgang CL. The role of surgery in the manage- ment of isolated metastases to the pancreas. Lancet Oncol 2009;10:287-93. 15. Tobisu K. Function-preserving surgery for urologic cancer. Int J Clin Oncol 2006;11:351-6. thesurgery.or.kr