Surgical Treatment Options for Renal Cell Carcinoma Metastases to the Pancreas—25 Years of Single-Center Experience

<b>Background</b>: Clear cell renal cell carcinoma (RCC) is the most common primary tumor that metastasizes to the pancreas, and surgery is the established treatment option. The aim of this study was to compare surgical treatment options for RCC metastases to the pancreas and to assess long-term outcomes, identifying risk factors for recurrence and death. <b>Methods</b>: We retrospectively analyzed data from 62 patients with RCC metastases to the pancreas who underwent pancreatic surgery at the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice. Patients were divided into two groups: those who underwent local tumor removal (group A, N = 10) and those who underwent classical pancreatic resection (group B, N = 52). Demographic data, postoperative course, histological findings, and clinical outcomes-recurrence-free survival (PFS) and overall survival (OS)-were analyzed. <b>Results</b>: In group A, tumors were smaller (<i>p</i> < 0.001) and exclusively single (<i>p</i> = 0.100), and Clavien-Dindo complications were milder, with a predominance of grade 0 (90% vs. 28.8%; <i>p</i> = 0.042). In group B, blood loss was greater (<i>p</i> < 0.001), and hospitalization was longer (median 12.5 days vs. 10.5 days; <i>p</i> = 0.022) compared with group A. Group A had a longer PFS (144 months vs. 61 months; <i>p</i> = 0.007) and longer OS (144 months vs. 70 months; <i>p</i> = 0.006) compared with group B. In the entire cohort, independent factors associated with worse OS in multivariate analysis were larger tumor size (<i>p</i> = 0.003), lymphatic invasion (<i>p</i> < 0.001), vascular invasion (<i>p</i> < 0.001), perineural invasion (<i>p</i> < 0.001), R1 resection (<i>p</i> < 0.001), and symptoms of the metastases (<i>p</i> < 0.001). <b>Conclusions</b>: The prognosis following surgical resection of pancreatic RCC metastases is excellent: median OS is 77 months, and 5-year survival reaches 71.4%. In multivariate analysis, the type of surgical treatment is not significantly associated with OS or PFS. The choice of surgical procedure should depend on the preoperative CT results and the intraoperative assessment of the surrounding tissues.