Resection of Pancreas and Duodenum During Radical Nephrectomy: Analysis ofA Single Center Experience

Introduction: To analyze our experience of radical nephrectomy (RN) with en-bloc resection of neighboring organs for T4 renal cell carcinoma (RCC) based on our experience with multivisceral transplantation techniques. Materials and Methods: After Institutional Review Board approval, a retrospective review was performed for patients who underwent RN and resection of adjacent organs and with a minimum follow up of 6 months. Results: Ten patients underwent RN along with resection of pancreas (80%) and 2nd portion of duodenum (30%). Other organs simultaneously removed were inferior vena cava (IVC) (30%), spleen (70%), adrenal (100%), and left colon (10%). Major complications (Clavien-Dindo grade ≥ III) were seen in 6 patients (60%). The overall recurrence rate was 70%.The 2-year overall survival (OS) was 42.9 ± 13% and 2-year disease free survival (DFS) 28.6 ± 4.6%. Conclusions: Those patients that undergo complete resection of T4 RCC face a high recurrence rate, but some have potential for durable survival response. Multi-institutional studies are needed to determine those patients that may benefit from aggressive surgical interventions, and should be considered for clinical trials of adjuvant targeted therapies.