Successful Surgical Management of Locally Advanced Renal Cell Carcinoma Invading Spleen and Pancreas

Main Article Content

Mohamed Sharafeldeen
Vahid Mehrnoush
Asmaa Ismail
Ahmed Zakaria
Hazem Elmansy
Walid Shahrour
Owen Prowse
Ahmed Kotb https://orcid.org/0000-0002-1484-1332

Keywords

RCC, nephrectomy, splenectomy, pancreatectomy

Abstract

Over the last two decades, the treatment of metastatic RCC has changed significantly, and the role of surgery is being debated. A 50-year-old man presented with pain in his left loin. An ultrasound, followed by a CT scan, revealed a 17.5 cm left renal mass invading the left suprarenal gland, spleen, and pancreatic tail. Radical nephrectomy through chevron incision under epidural block with general anesthesia was performed. The entire mass was removed en bloc. The estimated blood loss was 300 mL, and no blood transfusions were performed. The operation took approximately 2 h. Histological examination revealed clear cell renal carcinoma with extension into the spleen, pancreatic tail, and diaphragmatic fibers with negative resection margin. The patient discharged after a 3-day uneventful hospital stay. Aggressive surgical removal of a locally invasive renal cell carcinoma is feasible and should be considered in patients with good performance status and no or minimal distant metastases.

Abstract 206 | PDF Downloads 193 HTML Downloads 20 XML Downloads 5

References

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. 10.3322/caac.21551

2. Capitanio U, Coleman J, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2018;75(1):74–84. 10.1016/j.eururo.2018.08.036

3. Capitanio U, Montorsi F. Renal cancer. Lancet. 2016;387(10021):894–906. 10.1016/S0140-6736(15)00046-X

4. Dudani S, de Velasco G, Wells C, Gan CL, Donskov F, Porta C, et al. Sites of metastasis and survival in metastatic renal cell carcinoma (mRCC): Results from the International mRCC Database Consortium (IMDC). J Clin Oncol. 2020;38(6_suppl):642. 10.1200/JCO.2020.38.6_suppl.642

5. Vergho DC, Loeser A, Kocot A, Spahn M, Riedmiller H. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma—Clinical and oncological outcome of 50 patients after surgery. BMC Res Notes. 2012;5:5. 10.1186/1756-0500-5-264

6. Hiotis SP, Klimstra DS, Conlon KC, Brennan MF. Results after pancreatic resection for metastatic lesions. Ann Surg Oncol. 2002;9(7):675–9. 10.1007/BF02574484

7. Fabre JM, Rouanet P, Dagues F, Blanc F, Baumel H, Domergue J. Various features and surgical approach of solitary pancreatic metastasis from renal cell carcinoma. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 1995;21(6):683–6. 10.1016/s0748-7983(95)96079-1

8. Huscher CG, Mingoli A, Sgarzini G, Mereu A. Laparoscopic left nephrectomy with “en bloc” distal splenopancreatectomy. Ann Surg Oncol. 2012;19(2):693. 10.1245/s10434-011-1966-y

9. Abdul-Muhsin HM, Stern KL, Katariya NN, Castle EP. Robot assisted “en bloc” radical nephrectomy, splenectomy and distal pancreatectomy for renal cell carcinoma: Case report and illustration of technique. J Robot Surg. 2016;10(4):375–8. 10.1007/s11701-016-0614-8

10. Pantel K, Cote RJ, Fodstad O. Detection and clinical importance of micrometastatic disease. J Natl Cancer Inst. 1999;91(13):1113–24. 10.1093/jnci/91.13.1113

11. van der Veldt AAM, Meijerink MR, van den Eertwegh AJM, Bex A, de Gast G, Haanen JBAG, et al. Sunitinib for treatment of advanced renal cell cancer: Primary tumor response. Clin Cancer Res. 2008;14(8):2431–6. 10.1158/1078-0432.CCR-07-4089

12. Barata PC, Rini BI. Treatment of renal cell carcinoma: Current status and future directions. CA Cancer J Clin. 2017;67(6):507–24. 10.3322/caac.21411

13. Méjean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K, et al. Sunitinib alone or after nephrectomy in metastatic renal cell carcinoma. N Engl J Med. 2018;379(5):417–27. 10.1056/NEJMoa1803675

14. Antoine SG, Pfeifer Z, Carroll AM, Reece TB, Lloyd GL. Management of locally advanced renal cell carcinoma. AME Med J. 2021;6:5. 10.21037/amj-20-79

15. Moir JAG, Sen G, Saif R, Haugk B, French JJ. Isolated splenic metastasis from renal cell carcinoma: Case report and review. Case Rep Gastroenterol. 2011;5(1):166–71. 10.1159/000326963

16. dos Santos Romao D, Horvat N, Castro Gonçalves M, Abe ES, Dumarco RB, Viana PCC, et al. Isolated splenic metastases from renal cell carcinoma 11 years after surgery. Case Rep Med. 2019;2019:7480479. 10.1155/2019/7480479

17. Kaur Grewal S, Doley RP, Roy K, Singla M, Malhotra M, Bawa AS, et al. Isolated splenic metastasis from clear cell renal carcinoma—A case report. Int J Surg Case Rep. 2016;29:44–6. 10.1016/j.ijscr.2016.10.045

18. Showalter SL, Hager E, Yeo CJ. Metastatic disease to the pancreas and spleen. Let us know how access to this document benefits you. 2008. Department of Surgery Faculty Papers. Paper 13.

19. Piskorz Ł, Mitura K, Olejniczak W, Misiak P, Jablonski S. Atypical locations of renal Cell carcinoma metastases to the pancreas and duodenum. Res Rep Urol. 2021;13:17–24. 10.2147/RRU.S290150.

20. González J, Gaynor JJ, Ciancio G. Renal cell carcinoma with or without tumor thrombus invading the liver, pancreas and duodenum. Cancers (Basel). 2021;13(7):1695. 10.3390/cancers13071695