Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):83-89. 10.14701/ahbps.2018.22.1.83.

Laparoscopic pancreaticoduodenectomy for renal cell carcinoma metastasized to ampulla of Vater: A case report and literature review

• Cheong D
• Rho SY
• Kim JH
• Kang CM
• Lee WJ

• KMID: 2409085
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.83

Abstract

Renal cell carcinoma is the most common primary renal neoplasm in adults. Although renal cell carcinoma is known to spread to unusual sites, the ampulla of Vater is considered a rare site for metastasis. Here we present a case of renal cell carcinoma metastasized to the ampulla of Vater along with literature review. A 62-year-old Korean male had a history of hypertension and right-sided renal cell carcinoma diagnosed in September 2004, for which he underwent right radical nephrectomy in October 2004. The patient eventually underwent laparoscopic pylorus-preserving total pancreaticoduodenectomy in January 2017. The surgery was successful without postoperative complications. Previous studies have shown that surgical resection for solitary metastases of renal cell carcinoma can provide favorable survival rates. Our case report provides evidence that pancreaticoduodenectomy may be a treatment of choice for suitable patients with solitary renal cell carcinoma ampullary metastasis. A minimally invasive approach may result in early recovery of patient to be suitable for subsequent chemotherapy. Further evidence is needed to address the exact role of minimally invasive pancreaticoduodenectomy in renal cell carcinoma metastasized to the ampulla of Vater.

Keyword

Renal cell carcinoma; Pancreas metastasis; Laparoscopic; Pancreaticoduodenectomy

MeSH Terms

Adult
Ampulla of Vater*
Carcinoma, Renal Cell*
Drug Therapy
Humans
Hypertension
Kidney Neoplasms
Male
Middle Aged
Neoplasm Metastasis
Nephrectomy
Pancreaticoduodenectomy*
Postoperative Complications
Survival Rate

Figure

• 

  Fig. 1 (A) Endoscopic view showing whitish firm mass from the superior duodenal angle to the ampulla of Vater. (B) Preoperative MRI pancreaticobiliary T2 weighted image showing a papillary shaped mass in the ampulla of Vater with duodenal and pancreas extension. (C) PET-CT showing increased FDG uptake of the tumor involving the duodenum and pancreatic head. T, tumor.

• 

  Fig. 2 Operative findings after resection phase. (A) Bile duct was clamped and the gastroduodenal artery (GDA) was ligated. (B) Reconstruction phase of laparoscopic pancreaticojejunostomy (duct-to-mucosa). (C) Reconstruction phase of laparoscopic hepaticojejunostomy. (D) Specimen gross finding showing the protruding mass on the ampulla of Vater. BD, bile duct; GDA, gastroduodenal artery; Pan, pancreas; PV, portal vein; J, jejunum; T, tumor; CBD, common bile duct; AoV, ampulla of Vater.

• 

  Fig. 3 Pathologic report. (A) Tumor invading the proper duodenum muscle layer (×12.5). (B) Characteristic appearance of renal clear cell carcinoma with clear cytoplasm arranged in nests (×100). Dm, Duodenum mucosa; BG, Brunner's gland; Pm, Proper muscle layer; T, Tumor.

• 

  Fig. 4 Literature review-based oncologic outcome analysis of patients with metastatic renal cell carcinoma to the ampulla of Vater. (A) Overall survival between patients who underwent palliative procedures and those who underwent resectional operations. (B) Overall survival between the two groups of patients according to age. (C) Overall survival between the two groups of patients according to gender. (D) Overall survival between the two groups of patients according to the interval time from initial nephrectomy to diagnosis of metastasis.

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