# Ultra-late pancreatic metastases from renal cell carcinoma after nephrectomy: two case reports and a literature review

## TL;DR

This paper reports two rare cases of kidney cancer spreading to the pancreas many years after initial treatment, highlighting the need for long-term monitoring and potential surgical options.

## Contribution

The novelty lies in documenting ultra-late pancreatic metastases from RCC and advocating for lifelong follow-up and aggressive surgical approaches when feasible.

## Key findings

- Two cases of pancreatic metastases from RCC were detected 16 and 20 years after nephrectomy.
- Both patients underwent successful robot-assisted distal pancreatectomy with confirmed PM-RCC diagnosis.
- Carbonic anhydrase-IX-targeted PET/CT is suggested as a helpful tool for preoperative diagnosis.

## Abstract

Pancreatic metastases of renal cell carcinoma (PM-RCC) are relatively rare. However, they exhibit unique biological behavior, often presenting as late-onset metastases with a relatively favorable prognosis. This report presents two cases of pancreatic masses detected 16 and 20 years, respectively, after radical nephrectomy for renal cell carcinoma (RCC). Both patients were asymptomatic, with the masses identified during routine health examinations. Each patient successfully underwent robot-assisted distal pancreatectomy with splenectomy. Pathological examination confirmed the diagnosis of PM-RCC in both cases, illustrating the characteristic of ultra-late metastasis in RCC. This underscores the necessity for lifelong follow-up in RCC patients and maintaining a high index of suspicion for metastasis when new pancreatic lesions are identified. Carbonic anhydrase-IX-targeted PET/CT may be helpful as an adjunct for preoperative differential diagnosis. Our findings suggest that an aggressive surgical approach may be considered for patients in whom complete resection appears feasible.