Pancreatic metastases from renal cancer: comparing surgery and pharmacotherapy efficacy

Background. Today, targeted therapy is a standard treatment in advanced renal cell carcinoma, while the surgical method plays the role of a possible approach in a select category of patients with solitary and single metastases.

The study objective to compare the effectiveness of two alternative treatment approaches: the surgical method and modern pharmacotherapy in achieving long-term overall survival of patients with pancreatic metastases of renal cell carcinoma.

Materials and methods. A retrospective two-center study was conducted. The cohort of surgical treatment included patients (n = 56) who underwent surgery for pancreatic metastases from renal cell carcinoma at the N.N. Blokhin National Medical Research Center of Oncology and A.V. Vishnevsky National Medical Research Center of Surgery in the period from 1990 to 2019. Operations were performed for all types of pancreatic lesions: synchronous/metachronous, solitary/single and multiple, isolated/combined with lesions of other organs. Postoperative mortality rate was 5 % (3 patients). The pharmacotherapy cohort (n = 28) included patients with potentially resectable pancreatic metastases from clear cell renal cell carcinoma who underwent targeted therapy. Survival was assessed using the Kaplan–Mayer method. The Mantel–Cox test was used to test null hypothesis.

Results. The 5-year overall survival rate was 68 % in the surgery group compared to 35 % for the pharmacotherapy group. Median overall survival for surgical and non-surgical patients was 82 months and 43 months, respectively (p = 0.01). The advantage of the surgical method was also found in a subgroup survival analysis of patients with extrapancreatic disease (p = 0.037). In this case, the 5-year overall survival rate was 66 % in the surgery subgroup (n = 25) compared to 35 % for the pharmacotherapy subgroup (n = 24). Conclusion. Radical surgical treatment in comparison with modern pharmacotherapy allows to achieve significantly higher rates of overall survival in patients with pancreatic metastases of renal cell carcinoma and can be considered as a priority.

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