Urgent total pancreatoduodenectomy for profuse gastro-intestinal bleeding caused by renal cancer metastases to the pancreas

Abstract

Renal cancer (RC) can spread to different organs, metastatic damage of the pancreas is quite rare. But, in contrast of primary and other metastatic malignant tumors, pancreatic RC metastases can be resectable in 80 % of cases with nearly 90 % 5-year survival rate. Pancreatic oncologic surgery includes 3 different types of resection: distal pancreatic resection, pancreatoduodenal resection and total duodenopancreatectomy. The last type is the most extensive procedure, incorporates except of total removal of the pancreatic gland, total excision of duodenum and, in some cases, partial gastrectomy. In surgery of pancreatic tumors using of total duodenopancreatectomy is relatively rare (6,7-12,3 %). And in spite of low mortality (5-6,25 %) in recent years, whole removal of the gland inevitably leads to severe metabolic changes such as complete exocrine insufficiency and unstable insulin-depended diabetes mellitus which need lifetime medical correction. Gastrointestinal bleeding from pancreatic metastases of RC as a disease complication occurs quite rare and appears due to invasion of cancer tissue located in the pancreatic head to duodenal mucosa and then ulcerated. There are few single observations or little series (2-4 cases) described in literature. Pancreatoduodenal resection in such cases is the main type of surgical intervention. Now we present a case of successful urgent total duodenopancreatectomy, performed for recurrent profuse gastrointestinal bleeding from pancreatic head metastasis of RC invaded duodenum after previously radical nephrectomy. During the operation several cancer nodes in the pancreatic body and tail were found that defined the total gland removal. Postoperative period proceeded uneventfully and the patient was discharged on 15th day. Uniqueness of this case is that emergency total duodenopancreatectomy was successfully done for profuse gastrointestinal bleeding as the only possible chance for cure. We have not found similar reports in the available literature.