Middle-Preserving Pancreatectomy for Multifocal Metastatic Renal Cell Carcinoma Located in the Head, Body and Tail of the Pancreas. A Case Report
Abstract
Context Postoperative endocrine and exocrine insufficiencies following traditional pancreatectomies might cause a deterioration of the quality of life and surgical outcome. Parenchyma-sparing pancreatectomies have been utilized in benign lesions and low-grade malignancies. Case report A 67-year-old female with a past history of right nephrectomy for renal cell carcinoma 20 years earlier was referred to our institute with obstructive jaundice and multiple nodules in the pancreas. Computed tomography demonstrated five well-demarcated, strongly enhanced nodules with diameters of 5.5 cm in the head, 2.0 and 1.8 cm in the body, and 1.2 and 1.0 cm in the tail. Fluorine-18 fluorodeoxyglucose positron emission tomography did not demonstrate any extrapancreatic uptake. A middle-preserving pancreatectomy was performed after ultrasonography had confirmed arterial perfusion in the middle segment. A histological study demonstrated metastatic clear cell renal carcinoma. To date, the patient has remained without recurrence for two and a half years since surgery. A minimal administration of insulin has been necessary; however, C-peptide is detectable and nutritional status is comparatively good. Conclusion A middle-preserving pancreatectomy is a useful procedure in a parenchyma-sparing pancreatectomy for resecting multifocal lesions in the head, body and tail of the pancreas.
Image: Procedure for a middle-preserving pancreatectomy: reconstruction following a middle-preserving pancreatectomy.
Downloads
References
Sarr MG, Behrns KE, van Heerden JA. Total pancreatectomy: an objective analysis of its use in pancreatic cancer. Hepatogastroenterology 1993; 40:418-21. [PMID 7903658]
Sun AM, Coddling JA, Haist RE. A study of glucose tolerance and insulin response in partially depancreatized dogs. Diabetes 1974; 23:424-32. [PMID 4598091]
Mizumoto R, Kawarada Y, Goshima H, Tamaki H, Sekiguchi T, Tomikawa I. Carbohydrate metabolism and endocrine function in the pancreas remnant after major pancreatic resection. Am J Surg 1982; 143:237-43. [PMID 7036771]
Seaquist ER, Kahn SE, Clark PM, Hales CN, Porte D Jr, Robertson RP. Hyperproinsulinemia is associated with increased beta cell demand after hemipancreatectomy in humans. J Clin Invest 1996; 97:455-60. [PMID 8567967]
Skogseid B. Multiple endocrine neoplasia type I. Br J Surg 2003; 90:383-5. [PMID 12673737]
Zerbi A, Ortolano E, Balzano G, Borri A, Beneduce AA, Di Carlo V. Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection? Ann Surg Oncol 2008; 15:1161-8. [PMID 18196343]
Sellner F, Tykalsky N, De Santis M, Pont J, Klimfinger M. Solitary and multiple isolated metastases of clear cell renal carcinoma to the pancreas. Ann Surg Oncol 2006; 13:78-85. [PMID 16372157]
Salvia R, Crippa S, Falconi M, Bassi C, Guarise A, Scarpa A, Pederzoli P. Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut 2007; 56:1086-90. [PMID 17127707]
Takada T, Amano H, Ammori BJ. A novel technique for multiple pancreatectomies: removal of uncinate process of the pancreas combined with medial pancreatectomy. J Hepatobiliary Pancreat Surg 2000; 7:49-52. [PMID 10982591]
Warshaw AL, Rattner DW, Fernandez-del Castillo C, Z'graggen K. Middle segment pancreatectomy. A novel technique for conserving pancreatic tissue. Arch Surg 1998; 133:327-31. [PMID 9517749]
Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg 2007; 94:1254-9. [PMID 17583892]
Deguchi Y, Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T, Hiraoka N. Pancreaticojejunostomy with invagination of the punched pancreatic remnant after medial pancreatectomy and enucleation for multiple metastases of renal cell carcinoma: report of a case. Surg Today 2009; 39:1086-90. [PMID 19997808]
Siassi M, Klein P, Hohenburger W. Organ-preserving surgery for multicentric carcinoma of the pancreas. Eur J Surg Oncol 1999; 25:548-50. [PMID 10527608]
Miura F, Takada T, Amano H, Yoshida M, Toyota N, Wada K. Middle-segment-preserving pancreatectomy. J Am Coll Surg 2007; 204:720-2. [PMID 17382235]
Partelli S, Boninsegna L, Salvia R, Bassi C, Pederzoli P, Falconi M. Middle-preserving pancreatectomy for multicentric body-sparing lesions of the pancreas. Am J Surg 2009; 198:e49-53. [PMID 19716880]
Sperti C, Polizzi ML, Moro M, Beltrame V, Pedrazzoli S. Middle-preserving pancreatectomy: an interesting procedure for pancreas-sparing resection. JOP. J Pancreas (Online) 2010; 11:258-61. [PMID 20442523]
Matsubayashi H, Uesaka K, Kanemoto H, Sugiura T, Mizuno T, Sasaki K, et al. Multiple endocrine neoplasms and serous cysts of the pancreas in a patient with von Hippel-Lindau disease. J Gastrointest Cancer 2010; Feb 6. [PMID 20140653]
Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach. Lippincott Williams & Wilkins 1997. [ISBN 978-0-7817-6081-2]
Frey CF, Child CG III, Fry W. Pancreatectomy for chronic pancreatitis. Ann Surg 1976; 184:403-14. [PMID 1015887]
Jalleh RP, Williamson RC. Pancreatic exocrine and endocrine function after operations for chronic pancreatitis. Ann Surg 1992; 216:656-62. [PMID 1466619]
Slezak LA, Anderson DK. Pancreatic resections: effects on glucose metabolism. World J Surg 2001; 25:452-60. [PMID 11344398]
Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 2002; 236:612-8. [PMID 12409667]
Copyright (c) 2010 Hiroki Ohzato, Tameyoshi Yamamoto, Mutsumi Fukunaga, Hiroshi Imamura, Hiroshi Furukawa
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.