Robotic treatment of oligometastatic kidney tumor with synchronous pancreatic metastasis: case report and review of the literature

• Published in: BMC surgery Vol. 18; no. 1; p. 40
• Main Authors: Boni, Andrea, Cochetti, Giovanni, Ascani, Stefano, Del Zingaro, Michele, Quadrini, Francesca, Paladini, Alessio, Cocca, Diego, Mearini, Ettore
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.06.2018; BioMed Central; BMC
• Subjects: Aged; Bladder cancer; Blood vessels; Carcinoma, Renal Cell - surgery; Care and treatment; Case Report; Case reports; Case studies; Complications; Complications and side effects; Development and progression; Dissection; Distal atypical pancreasectomy; Female; Health aspects; Hematuria; Humans; Immunotherapy; Kidney cancer; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy; Lesions; Literature reviews; Medical prognosis; Metastasectomy; Metastases; Metastasis; Nephrectomy; Operative Time; Pancreas; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - secondary; Pancreatic Neoplasms - surgery; Parenchyma; Patients; Peritoneum; Prognosis; Renal cell carcinoma; Risk factors; Robot-assisted surgery; Robotic surgery; Robotic Surgical Procedures - methods; Robots; Spleen; Spleen-preservation; Surgeons; Surgery; Thromboembolism; Thrombosis; Treatment Outcome; Tumor removal; Tumors; Urothelial cancer; United States > US; Spleen-preservation; Metastasectomy; Robot-assisted surgery; Distal atypical pancreasectomy; Kidney cancer
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-018-0371-x

The management of metastatic Renal Cell Carcinoma (RCC) has changed dramatically in the last 20 years, and the role of surgery in the immunotherapy's era is under debate. Metastatic lesions interesting pancreas are infrequent, but those harbouring from RCC have an high incidence. If metachronous resections are not rare, synchronous resection of primary RCC and its pancreatic metastasis is uncommonly reported, and accounts for a bad prognosis. We report the case of a 68 years old woman, who presented hematuria at hospital incoming, with radiological appearance of a 13 cm left renal mass, with a 2.5 cm single pancreatic tail metastasis. Work-up of staging ruled out other distant metastases, urothelial cancer and there was no evidence of inferior vena cava thrombosis. We choose a 5-port trans-peritoneal robotic approach using lazy right lateral decubitus. Synchronous robotic radical nephrectomy and spleen-sparing pancreatic resection was performed. The pancreatic mass was completely enucleated from pancreatic parenchyma using a latero-medial dissection. Peri-operative hemoglobine loss was 2.4 g/dL. Total operative time was 213 min. No post-operative complications were recorded and patient was discharged in 7th post-operative day. Histopathological examination showed a pT2b N0 M1 RCC, Fuhrman grade II, with pancreatic tail metastasis; both, primary and metastatic lesions had the same histological characteristics with negative surgical margins. After 9 months patient had no evidence of disease recurrence at radiological studies. The rationale for surgical removal of disseminated tumor, followed by immunotherapy, includes improving prognosis and enhancing the potential of an immune-mediated response to systemic treatment. A spleen-sparing procedure can adequately preserve post-operative immunologic capabilities. In our experience, the correct assessment of pre-operative imaging data and surgeon skills in robotic surgery seem to play a key role in the success of these procedures. Robotic surgery seems to enhance the possibility to control multiple vessels encountered during dissection. Such a conservative approach may be helpful in future research aimed at uncovering biological features, and also leading to better targeted preventive interventions and more individualized and effective treatments.