Dong Do You, et al. trapancreatic disease (2 RCC and 1 carcinoid). The patient with carcinoid tumor had a mass about 10 × 6 cm in the an- terior mediastinum. Percutaneous fine needle biopsies of the mediastinal and pancreatic masses were performed and returned a diagnosis of metastatic carcinoid. The one patient with RCC, who had previously undergone partial nephrectomy for right RCC, had 2 metastatic lesions, in the posterior of pancreatic body and in the tail of the pan- creas, respectively, according preoperative imaging studies. After exploration, however, the mass in the posterior of pancreatic body was found to be extrapancreatic. The oth- er patient with RCC visited other hospital due to neck mass and underwent unilateral thyroidectomy, which pathologic diagnosis was clear cell carcinoma from RCC. After referral to our institution and work up for systemic spread of RCC, another lesion was detected in the tail of the pancreas by CT. These 3 patients underwent surgical resection for multiple metastases due to the treatment principle of the primary tumor with metastatic lesion. Before surgery, 8 of the 11 patients had a high clinical suspicion of a metastatic lesion. In the other three patients with RCC, rectal cancer, and leiomyosarcoma, metastatic tumors were initially misdiagnosed as pancreatic endo- crine tumor, primary pancreatic carcinoma and cystic tu- mor, respectively. One patient with rectal cancer received concurrent chemoradiotherapy after primary surgery, and one patient with leiomyosarcoma in the right inguinal Table 2. Surgical treatment and follow-up survivals Patients Prdeioapgenroastiisve Operation Aprsosocecdiautered 1 Metastasis Distal pancreatectomy Thyroidectomy 2 Pancreatic endocrine Distal pancreatectomy − tumor 3 Metastasis PPPD − 4 Metastasis Distal pancreatectomy Wide excision 5 6 7 8 Metastasis Metastasis Metastasis Metastasis Distal pancreatectomy − 4.0 Enucleation − 0.9 Enucleation − 1.3 Total pancreatectomy Mediastinal mass 8.5 excision 9 Metastasis Distal pancreatectomy − 1.5 10 Pancreatic cancer Distal pancreatectomy − 2.2 11 Cystic tumor PPPD − 4.0 PPPD, pylorus-preserving pancreaticoduodenectomy. area underwent radiotherapy due to a positive resection margin after wide excision. In 9 patients, tumors were resected with curative intent and enucleation was performed in 2 patients because metastatic tumor was small and exophytic. Pancreatico- duodenectomy was performed in three patients including total pancreatectomy, and distal pancreatosplenectomy was performed in the other 6. In the patient with a media- stinal mass, wide excision of the tumor was combined with pancreatic resection. There was no perioperative death. Postoperative complications occurred in 3 patients: two experienced a postoperative pancreatic fistula (POPF) of grade A and B, as defined by the International Study Group of Pancreatic Surgery, and the other POPF of grade B and an intra-abdominal abscess. The former resolved with conservative treatment and the latter was treated with percutaneous drainage. In all 11 cases, pancreatic metastases had the same histopathologic features as pri- mary tumors; median tumor size was 3.2 cm (range, 0.9 to 8.5 cm). One patient died of metastatic RCC at 53 months postoperatively. Ten patients remain alive: four patients with a disease-free status at 7 to 69 months postopera- tively, and the other six with disease at 11 to 68 months (Table 2). Median postoperative survival of 11 patients who all underwent surgery for metastatic pancreatic le- sions was 34 months (range, 7 to 69 months). Tumor size (cm) 4.8 5.0 Athdejuravpaynt Follow-up Immunotherapy Brain metastasis − Lung metastasis Status Survival (mo) Alive 68 Dead 53 3.2 3.0 − Liver, lung metastasis Alive − Right adrenal, Alive lung metastasis Immunotherapy Lung metastasis Alive Chemotherapy Disease free Alive Immunotherapy Disease free Alive − Local recurrence Alive − − Radiotherapy Disease free Disease free Lung metastasis Alive Alive Alive 12 32 34 7 69 11 12 30 21 280 thesurgery.or.kr