**9. Pancreatic metastases from uterine body or cervix cancer**

as part of tertiary cytoreduction. The patient submitted to primary cytoreduction benefitted from a distal pancreatectomy in association with splenectomy which was associated to a total hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection and parcelar gastrectomy; the long-term outcome was a favorable one, the patient being diagnosed with relapse at 54 months follow-up. Patients submitted to pancreatic resections as part of secondary cytoreduction experienced a median disease free interval of 32 months and necessitated in all cases a distal pancreatectomy. Postoperatively, two patients developed pancreatic leaks which were treated conservatively in one case and through reoperation in the second case. When it comes to the long-term outcomes, the median overall survival was 36.38 months, all cases being dead of disease at the end of the study. At the time of tertiary cytoreduction, pancreatic resection was performed in a single case, 52 months after the initial diagnostic. Although the early postoperative outcome was favorable, the patient died of disease 10 months later. The authors demonstrated in this way the effectiveness of pancreatic resections as part of cytoreductive surgery in the setting of advanced stage disease as well as

for patients diagnosed with recurrent lesions [45].

necessitating pancreatic resections

necessitating pancreatic resections

necessitating pancreatic resections

necessitating pancreatic resections

necessitating pancreatic resections

**Table 2.** Outcomes after pancreatic resections for pancreatic metastases from ovarian carcinomas.

2001–2004 482 cases, 12 patients necessitating pancreatic resections

2002–2004 6 cases, 2 patients necessitating pancreatic resections

2000–2003 57 cases, 6 patients necessitating pancreatic resections

**No. of patients Type of** 

**pancreatic resection**

**Early postoperative outcomes**

DP: 3 cases 0 Not reached at the end of

DP: 6 cases NR Not reached at 36 months

DP: 2 cases 0.6% 106 months—in cases

DP: 9 cases 1% Overall survival after

DP: 2 cases 0 Overall survival after

DP: 17 cases 1.4% Overall survival after

DP: 12 cases Not reported Overall survival after

DP: 13 cases 2% Overall survival after

**Long-term outcomes**

the study (for the entire

follow-up (for the entire

submitted to complete cytoreductive surgery

pancreatic resections: 54

pancreatic resections: not

pancreatic resections: 57

pancreatic resections: 54.6

pancreatic resections: 49

group)

group)

months

reported

months

months

months

**Period of the study**

Chi, 2004 [47] 2001–2002 70 cases, 3 patients

Chi, 2006 [48] 1989–2003 465 cases, 2 patients

Chi, 2009 [49] 2001–2004 210 cases, 9 patients

Chi, 2010 [51] 2001–2006 141 cases, 17 patients

Heitz, 2016 [53] 2005–2010 578 cases, 13 patients

Abbreviations: DP, distal pancreatectomy.

**Name, year of the study**

142 Advances in Pancreatic Cancer

Eisenhauer, 2000

Hoffman, 2007

Rodriguez, 2013

[50]

[52]

[43]

Pancreatic metastases from uterine primaries are other rare eventualities, only few cases being described so far [1, 54–56]. The main pattern of spread responsible for the apparition of pancreatic metastases with endometrial origin consists of hematogenous disseminations and it is usually responsible for the apparition of other distant lesions such as hepatic, pulmonary or splenic metastases [57]. Due to this aspect, pancreatic metastases from uterine carcinomas can be rarely treated with curative intent. The first authors who reported performing a surgical procedure for a pancreatic metastasis originating from an endometrial carcinoma came from the USA, in 1998; it was the case of a patient known with previous history of endometrial cancer who presented for upper digestive stenosis 3 years later. At this time, a 4 cm tumor located at the level of the uncinate process of the pancreas was found, so the patient was successfully submitted to surgery; unfortunately the authors did not report the performed surgical procedure or the outcome of this patient [2]. The first successful pancreatic resection for pancreatic metastases from endometrial cancer came from Dan Blazer, at *M.D. Cancer Center, Houston, Texas, United States of America,* in 2008. It was the case of a 56-year-old patient who had been previously submitted to surgery for endometrial cancer, at that moment a total hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection being performed; postoperatively, the patient was submitted to adjuvant radiotherapy. However, 31 months later, she was diagnosed with a pancreatic lesion measuring 3 × 3 cm in the pancreatic tail. The fine needle biopsy confirmed the metastatic origin, so the patient was resubmitted to surgery, a distal pancreatectomy being performed. The histopathological studies confirmed the metastatic origin of the lesion; however, 6 months later, the patient remained free of recurrent disease [55].

Pancreatic oligometastases with uterine cervix origin is another rare situation, a successful resection of such a lesion being reported for the first time by Wastell et al. in Westminster, London. The authors reported the case of a patient who had been initially treated by radiotherapy with curative intent for a squamous cell carcinoma; however, 5 years later, the patient was diagnosed with a pancreatic head tumor. At that moment a pancreatoduodenectomy was performed, the histopathological studies confirming the metastatic origin of this lesion; unfortunately the postoperative course was complicated by the apparition of a bronchopneumonia, the patient being dead 16 days later [58].

**11. Pancreatic cancer from sarcomas**

ity of resection with curative intent [7].

6 years after pancreatic resection [63].

still alive at the time of publishing the case [64].

curative resection is performed [65, 66].

**12. Conclusion**

Metastatic lesions with sarcomatous origin are usually associated with an extremely poor outcome due to the biological aggressiveness of such primaries. When encountered, pancreatic metastases with sarcomatous origin are reported as part of the systemic disease so most often surgery is no longer a valid therapeutic option. In cases presenting oligometastatic disease, surgery might be proposed whenever the biological status of the patient will permit it. A particular problem in such cases is related to the multifocality of such lesions and to the feasibil-

Pancreatic Resections for Metastatic Disease http://dx.doi.org/10.5772/intechopen.75571 145

Successful resection of pancreatic metastases from soft tissue sarcomas has been reported by the Japanese authors in two cases. The first patient had been initially diagnosed with a mesenchymal chondrosarcoma of the left thigh in 1986; 3 years later, the patient was diagnosed with isolated pancreatic lesions, the patient being submitted to surgery with curative intent; the patient remained alive for the next 10 years. The second case was initially diagnosed with a synovial sarcoma followed by pulmonary resection for metastatic disease; the case was further diagnosed with a solitary pancreatic lesion for which she was submitted to pylorus preserving pancreatoduodenectomy with good results, the patient remaining alive for more than

Another extremely interesting situation was reported by another Japanese team in 2016. The authors reported the case of a 44-year-old woman who had been previously submitted to surgery for a right fibular head osteosarcoma; 3 years later, the patient was diagnosed with a metastasis in the distal pancreas, so a laparoscopic distal pancreatectomy with spleen preservation was successfully performed; the histopathological studies confirmed the metastatic origin from the initial osteosarcoma. Although the patient also reported the apparition of lung metastases, 1 year later, she was resubmitted to surgery with curative intent, the patient being

A particular situation is represented by patients diagnosed with pancreatic metastases from uterine sarcomas, in cases presenting oligometastatic disease, surgery being considered as a valid option. Most often these lesions occur in patients who had been previously diagnosed with uterine leiomiosarcomas and might experience good long-term outcomes whenever a

Isolated pancreatic metastases suitable for resection are rare eventualities; the renal cell carcinoma origin being the most frequently reported situations. When diagnosed as metachronous isolated lesions, such metastases can be submitted to surgery with curative intent, long-term survival rates being reported. Another primary with good outcomes after pancreatic resections for metastatic disease is represented by ovarian cancer, debulking surgery to no residual disease

Another interesting case was reported by the Japanese authors in 2013 [59]. The authors reported the case of a 44-year-old patient who had been initially diagnosed with a stage IB uterine cervix cancer, the histopathological studies reporting a mixed adeno-neuroendocrine carcinoma; 8 years later, the patient was diagnosed with an isolated pancreatic tumor which was biopsied, a metastatic neuroendocrine tumor being revealed. At that moment a central pancreatectomy was performed, the histopathological studies confirming the presence of a metastatic lesion; however, only the neuroendocrine component seems to be responsible for the apparition of the recurrent disease. The long-term outcomes were favorable, the patient being free of disease at a 7 month follow-up [59].
