Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review
Abstract
1. Introduction
2. Methods
- (1)
- Patient characteristics: age, sex.
- (2)
- Clinical, biological, and radiological presentation: symptoms at diagnosis, biological abnormalities, CT scan results, endoscopic features, and other metastatic sites.
- (3)
- Tumor characteristics: side of the primary renal cancer, synchronous or metachronous presentation, and disease-free interval (defined as the time between resection of the initial tumor and diagnosis of duodenal metastasis).
- (4)
- Treatment and perioperative course: type of surgery performed and reported complications.
- (5)
- Outcome: overall survival.
3. Results
3.1. Data Extraction
3.2. Haracteristics of Patients
3.3. Clinical Presentation
3.4. Complementary Exams
4. Treatment and Outcome
4.1. Treatment Strategy
4.2. Surgical Procedure Outcomes and Comparison with Non Surgical Procedure Management
5. Discussion
5.1. Features of Duodenal Metastases
5.2. Role of Metastasectomy in Oligometastatic Renal Cell Carcinoma
- -
- Asymptomatic presentation
- -
- No extrahepatic diseases
- -
- Solitary metastasis
- -
- Absence of vascular invasion
- -
- Ability to complete resect tumor
5.3. Duodenal Metastases of RCC: Surgery and Outcome
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Ref. | Gender, Age | Clinical Presentation | Biological Abnormalities | CT SCAN | Endoscpîc Aspect/Localisation | Histological Proof of Renal Carcinoma | Nephrectomy Side | Delay After Nephrectomy | Treatment | Patient Outcome | Other Localization | Operated Patients- Complications |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Black, 1995 [7] | F, 60 years | Melena | Severe anemia | Mass invading pancreas | Periampullary lesion | Surgical sample | Right | Metachronous-6 years | Surgery | - | ||
Hsu, 1996 [8] | F, 54 years | Melena, anemia | Anemia | - | Second duodenum-polypoid mass | Endoscopic biopsy | - | Metachronous-1.5 years | Chemotherapy | Dead at 1 month | - | |
Hsu, 1996 [8] | F, 72 years | Melena, anemia | Anemia | Localized right renal tumor | Second duodenum-Submucosal mass with ulcerations | Endoscopic biopsy | Left | Metachronous-1 year | Treatment refused | Lost to follow up | Bone | |
Leslie, 1996 [9] | M, 53 years | Melena, weight loss | Bilirubin increase | Periampullary lesion | Endoscopic biopsy | Right | Metachronous 8 years | PD | Alive at 2.5 years | - | No complication | |
Toh, 1998 [10] | F, 59 years | Lethargy, abdominal pain, anorexia, weight loss, iron suplementation for chronic anemia | Anemia | Solid mass on the posterior wall of Duodenum | Normal | Surgical sample | Right | Metachronous-10 years | Wedge resection | - | - | Gastroplegia |
Janzen, 1998 [11] | M, 75 years | Melena, bleeding necessitating ressucitation | Severe anemia | Perimapullary mass extending to head of the pancreas | Periampullary mass | Endoscopic biopsy | Left | Metachronous-18 years | - | |||
Yavascaoglu, 1999 [12] | M, 63 years | Right flank pain, melena | - | Right renal tumor of 15 × 14 cm and pancreatico-duodenal mass 7 × 5 cm | Hemorrhagic area on the second duodenum | Endoscopic biopsy | Right | Synchronous | PD + interferon-Nephrectomy | Alive at 23 months | - | - |
Ohmura, 2000 [13] | M, 62 years | Occlusion | Enhanced mass of renal fossa invading psoas muscle and duodenum | Large elvated irregular shaped tumor, obstructive | Surgical sample | Left | Metachronous-5 years | Wedge resection | Dead at 1 month | Lung (surgery) | Peritonitis/bleeding at day-40: death | |
Hashimoto, 2001 [14] | M, 68 years | Dyspnea | Severe anemia | Wall thickening | Ulcerated tumor on duodenal bulb | Surgical sample | Left | Metachronous-11 years | PD | Alive at 18 months | - | No complication |
Lee, 2002 [15] | F, 76 years | Dyspepsia, abdominal pain, lump on upper right abdomen | - | Wall thickening | Endoscopic biopsy | Left | Metachronous-4 years | Medical treatment | Alive at 1 year | - | ||
Loualidi, 2004 [16] | M, 76, years | Weakness, dizziness, dyspnea, epigastric discomfort | Anemia | - | Periampullary–lobular mass | Endoscopic biopsy | Right | Metachronous-5 years | Paliative radiotherapy | Alive at 1 year | L5 | |
Chang, 2004 [17] | F, 63 years | 4 episodes of bleeding in 9 months | Severe anemia | - | Duodenal bulb-ulcerative mass | Endoscopic biopsy | Right | Metachronous-9 years | Surgery | Alive at 10 months | - | No complication |
Bhatia, 2006 [18] | M, 55 years | Jaundice, abdominal lump | Cytolysis, cholestasis | No mass | Second duodenum-submucosal lesion | Endoscopic biopsy | Left | Metachronous-1 year | Paliative radiotherapy | Lost to follow up | Liver | |
Sadler, 2007 [19] | M, 67 years | Melaena, lethargyy, recurent anemia ++ | Severe anemia | Polypoid mass, in the medial wall of D2 arising from pancreas & renal mass | Angulus-polyp | Endoscopic biopsy | Left | Synchronous | Nephrectomy + interferon | Dead 2 years | Lung & adrenal gland left | |
Sadler, 2007 [19] | M, 75 years | Chronic anemia | - | Pancreatic mass invading duodenum | Duodenal bulb-polyp | Endoscopic biopsy | Right | Metachronous-9 years | No treatment | - | - | |
Adamo, 2008 [20] | M, 86 years | Obstruction & anemia | - | Duodenal mass invading pancreas | - | Surgical sample | - | Metachronous-13 years | PD | Alive at 7 months | - | Pulmonary embolism |
Das, 2009 [21] | M, 68 years | Hematochezia | Anemia | - | Second duodenum-large friable, centrally ulcerated mass | Endoscopic biopsy | - | Metachronous-10 years | PD | Alive at 4 months | Lung | |
Teo, 2010 [22] | M, 50 years | Jaundice, abdominal pain | Cholestasis, cytolysis, bilirubin increase | Dilatation of the biliary duct | periampullary-mass | Endoscopic biopsy | Left | Metachronous-3 years | Antiangiogenics | 1 week | Lung | |
Kanthan, 2010 [3] | M, 69 years | Upper gastrointestinal bleeding | - | - | - | Endoscopic biopsy | - | Metachronous-8 years | - | - | - | |
HE, 2010 [23] | M, 62 years | Massive melena | Anemia, elevated CA 19-9 and ACE | Submucous tumor | Bleeding mass second duodenum | Surgical sample | Right | Metachronous-11 years | PD | Alive at 17 months | - | Gastroplegia |
Rustagi, 2011 [24] | M, 66 years | Melena, anemia, fatigue | Severe anemia | Mass | Second duodenum-actively bleeding and ulcerative mass | Endoscopic biopsy | Bilateral | Metachronous-13 years | PD | Dead at 2 weeks | - | Leakage of pancreaticojejunostomy fistula-sepsis |
Cherian, 2011 [25] | M, 80 years | Syncope, melena | Severe anemia | Soft tissue mass extending in duodenum from right nephrectomy bed | Second duodenum | Endoscopic biopsy | Right | Metachronous-1 years | Sorafenib, everolimus | Dead at 1 year | Lumbar vertebra-lung | |
Chara, 2011 [26] | M, 49 years | Melena | Enlargement of the head of the pancreas | Duodenal ulcer initially treated by sclerotherapy and biopsied 5 months after diagnosis | Surgical sample | Left | Metachronous-6 years | PD | Alive at 4 years | - | No complication | |
Yang, 2012 [27] | F, 72 years | Melena, fatigue, hematemesis | Severe anemia | - | Mass at second portion of duodenum bleeding and necrosis | Surgical sample | Left | Metachronous-10 years | Wedge resection | Recurrence at 10 months | - | Surgical site infection-Pulmonary infection |
Mandal, 2012 [28] | F, 60 yars | Melena-diarrhea | Nothing | No lesion on CT Scan | Second duodenum-abnormal duodenal border | Endoscopic biopsy | Left | Synchronous | Nephrectomy + chemotherapy | - | Skin | |
Zhao, 2012 [29] | M, 56 years | Occlusion-bleeding-fatigue | Severe anemia | filling defect | Second duodenum-ulcerated and hemorrhagic mass | Endoscopic biopsy | Right | Metachronous-7 years | Wedge resection | Alive at 1.5 years | Tail pancreatic lump non operated | No complication |
Chen, 2012 [30] | F, 76 years | Hematoschzia, anemia | Anemia | Hypervascular lesion involving duodenum, pancreas gastric antrum | First duodenum-submucosal mass involving stomach | Surgical sample | Left | Metachronous-6 years | PD | Aliver at 24 months | - | No complication |
Schlussel, 2012 [31] | M, 53 years | Melana, fatigue, | Severe anemia | Large mass (15 cm) arising of right kidney protruding into duodenum lumen | Second duodenum -bleeding mass | Surgical sample | Right | Synchronous | Nephrectomy + PD + thrombectomy + IL-2 | Alive at 3 months | Lung | No complication |
Gonzalo-Marin, 2012 [32] | M, 66 years | Melena | Anemia | Necrotic right renal mass with duodenum invasion-bile duct dilatation | Second duodenum-large and deep ulceration with edematous borders | Endoscopic biopsy | Right | Metachronous | - | - | Paraaortic LN-lUng | - |
Vashi, 2012 [33] | M, 53 years | Dyspnea | Severe anemia | Right renal lesion | First duodenum-2 small vascular polyps | Endoscopic biopsy | Right | Metachronous | Duodenotomy | Small intestine polyps | No complication | |
Ashraf Teli, 2012 [34] | M, 52 years | Gastro intestinal bleeding | Duodenal metastasis | Duodenal mass, bleeding | Surgical sample | Right | Metachronous-8 years | Duodenotomy | Died at 4 months | - | No complication | |
Karakatsanis, 2013 [35] | M, 77 years | Isolated jaundice | - | Dilatation of the biliary duct | Ampula-massI25 | Endoscopic biopsy | Right | Metachronous-3 years | Ampullectomy + biliary stent | Dead at 1.5 year | Lung/bone | |
Hata, 2013 [36] | M, 50 years | Anemia, melena | Severe anemia | Second duodenum-Ulcerated polypoid mass (not involving ampulla); NBIde,se assembly of microvessels | Endoscopic biopsy | Left | Metachronous-15 years | PD | Alive at 1 year | Bone (radiotherapy)-pancreas tail (surgery) | Leakage of gastrojejunostomy | |
Neofytou, 2014 [37] | M, 41 years | Massive GI bleeding | Anemia | - | Vater ampula | Endoscopic biopsy | Left | Metachronous-1 year | Initially under pazopanib, PD for emergency | Dead at 2 months | Adrenal gland bilatera, thoracic lymphnodes | |
Espinoza,2014 [5] | M, 58 years | Gastro intestinal bleeding | - | - | - | - | Right | Metachronous-12 years | PD | Alive at 12 months | - | |
Espinoza,2014 [5] | F, 66 years | Abdominal pain | - | - | - | - | Right | Metachronous-4 years | PD | Alive at 12 months | - | |
Haidong, 2014 [38] | M, 50 years | Fatigue–fever– diarrhea | Bilirubin increase-Cholestasis- moderate cytolysis | Presence of tumor | No endoscopy | Surgical sample | Right | Synchronous | PD + Radical nephrectomy FN alph-2b | Alive at 5 years | - | No complication |
Hu, 2014 [39] | M, 57 years | Dyspnea, dyspepsia, fatigue, anemia, melena | Severe anemia | Intraluminal enhancing lesion 6 cm | Bulb/second duodenum-polypoid ulcerative and friable mass bleeding with obstruction | Endoscopic biopsy | Right | Metachronous-12 years | PD + sunitinib | Alive at 6 months | - | No complication |
Osama Mohamed, 2015 [40] | M, 80 years | Melena, abdominal pain, dyspnea | Anemia | 8 cm mass lower pole of kidney invading duodenum | polypoidal mass anterior second duodenum bleeding | - | Right | Synchronous | Palliative treatment | - | - | |
Vootla, 2015 [41] | M, 74 years | Melena, weight loss | Anemia | Duodenal nodule | Endoscopic biopsy | Left | Metachronous-4 years | Paliative radiotherapy | - | Oesophagus | ||
Geramizadeh, 2015 [42] | M, 61 years | Melena | Normal | Mass invading duodenum and pancreas | Second duodenum-ulcer aspect | Endoscopic biopsy | Right | Metachronous-16 years | PD | - | No complication | |
Jideh, 2016 [43] | M, 50 years | Fever-abdominal pain-jaundice | Bilirubin increase-cholestasis | Biliary duct dilatation-no mass shown | Periampullary-mucosal mass | Endoscopic biopsy | Right | Metachronous | - | - | - | |
Sarocchi, 2016 [44] | M, 57 years | GI bleeding | Vater ampula irregular | Endoscopic biopsy | Left | Metachronous-3.5 years | PD | Alive a 4 years | - | No complication | ||
Saito, 2017 [45] | M, 64 years | Abdominal pain, fever, anorexia, weight loss | - | Hypervaslucar lesion duodenum and pancreatic head | Second duodenum apart form apula-submucosal mass with central ulcer | Endoscopic biopsy | Left | Metachronous-25 years | Pazopanib | - | Concomitant lymphoma treated-lung | |
Omranipour, 2017 [46] | M, 59 years | Melena | Anemia | Mass in nephrectomy bed invading D2 and D3 | Irregular, polypoid, ulcerative mass in second portion of duodenum | Endoscopic biopsy | Right | Metachronous-6 years | PD | Alive a 1 year | - | No complication |
Villela-Segura, 2018 [47] | F, 48 years | Burning and sharp epigastric pain, hematemesis, melena, fever, hypotension | Severe anemia | Mass in the second portion of duodenum | Mass at second portion of duodenum, submucosal, ulcerated surface, bleeding, 90% of stenosis | Endoscopic biopsy | - | Metachronous-1 year | - | Dead at 1 week | - | |
Podboy, 2018 [48] | M, 80 years | Melena | - | Hypervascularized mass of pancreas and duodenum | Ulcerated mass | Endoscopic biopsy | - | Metachronous-15 years | - | - | - | |
Ignatavicius, 2018 [49] | M, 62 years | Severe upper abdominal pain, jaundice, lethargy, subclinical obstruction | Bilirubin increase | Periampummary mass, pancreatic and bile duct dilatation | Tumor at paiplla | Surgical sample | Left | Metachronous-8 months | PD | Dead at 14 months | - | No complication |
Popovic, 2018 [50] | M, 58 years | Occlusion-bleeding | Anemia | Third duodenum-obstructive mass | Endoscopic biopsy | Left | Metachronous-7 months | Endoscopic thermocoagulation | Dead at 4 years | - | ||
Nakamura, 2019 [51] | M, 74 years | Vomiting, orthostatic fainting | Severe anemia | EUS: biliary duct dilatation and hypoechogenic mass | EUS biopsy | Right | Metachronous | - | - | - | No complication | |
Munir, 2019 [52] | M, 76 years | Asymptomatic-diagnosis at following | - | Mass | Second duodenum-friable mass | Endoscopic biopsy | Right | Metachronous-2 years | Sunitinib-nivolumab | - | - | |
Farrokh, 2019 [53] | M, 62 years | Fatigue, weigh loss, massive gastrointestinal bleeding | Mass in nephrectomy bed invading D2 and D3 | Second duodenum-irregular ulcerative mass | Endoscopic biopsy | Right | Metachronous-10 years | Embolization-axitinib | - | - | ||
Baghmar, 2019 [54] | M, 84 years | Fatigue, anemia, diarrhea | Severe anemia | Mass with central necrosis | First/second duodenum junction-ulcerations | Endoscopic biopsy | Right | Metachronous-37 years | Palliative treatment | - | ||
Jain, 2020 [55] | M, 73 years | Abdominal pain, nausea, vomiting, weight loss, hypertension, abdominal tenderness, anemia | Severe anemia | Lymph nodes in pancreaticoduodenal, para-aortic, precaval regions | Periampullary-ulcer | Endoscopic biopsy | Right | Metachronous-33 years | Immunotherapy | - | LN | - |
Peters, 2020 [56] | M, 68 years | Dyspnea, fatigue, anemia | Severe anemia | - | Second duodenum-polyp | Endoscopic biopsy | Right | Metachronous-1.5 years | Embolization-axitinib | Bones, live, LN |
Feature | n | Average/Percentage | |
---|---|---|---|
Male/Female ratio | 55 | 4/1 | |
Average age | 55 | 64 years | |
Metachronous vs. synchronous | 55 | ||
Metachronous | 49 | 89% | |
DFI (median) | 45 | 7 years | |
Synchronous | 6 | 11% | |
RCC side | 48 | ||
Bilateral | 1 | 2% | |
Left | 19 | 40% | |
Right | 28 | 58% | |
Symptoms | 54 | 55 | 98% |
Lethargy–general symptoms | 22 | 40% | |
Occlusion | 5 | 9% | |
Abdominal pain | 10 | 18% | |
Bleeding (upper and lower) | 36 | 65% | |
Upper GI bleeding | 12 | 22% | |
Lower bleeding (Melena, hematoschezia) | 26 | 47% | |
Anemia | 32 | 58% | |
Fever | 4 | 7% | |
Jaundice-cholestasis | 5 | 9% | |
Other metastasis site | 20 | 55 | 36% |
Localization of the tumor | 44 | ||
Second duodenum | 35 | 80% | |
Periampullary | 12 | 27% | |
Angulus | 2 | 5% | |
First Duodenum | 6 | 14% | |
Third duodenum | 1 | 2% | |
Treatment | 48 | ||
Surgery alone | 23 | 48% | |
Medical therapy alone | 11 | 23% | |
Surgery + medical therapy | 5 | 10% | |
Paliative RT | 3 | 6% | |
No treatment | 6 | 13% | |
Overall Survival-Median | 48 months |
Surgery (n = 28) | No Surgery (n = 20) | n | p | ||
---|---|---|---|---|---|
Age, median | 60.5 [55.2; 66.0] | 70.0 [59.5; 76.0] | 48 | 0.028 | |
Sex (Male proportion) | 22 (79%) | 16 (80%) | 38 | 1 | |
DFI, median | 8.00 [6.00; 11.0] | 4.00 [1.50; 9.25] | 41 | 0.067 | |
Bleeding/anemia | 22 (79%) | 15 (75%) | 37 | 1 | |
Localisation | D2 | 16 (80%) | 14 (74%) | 30 | 0.35 |
D1 | 4 (20%) | 2 (11%) | 6 | ||
ANGULUS | 0 (0%) | 2 (11%) | 2 | ||
D3 | 0 (0%) | 1 (5.3%) | 1 | ||
Metachronous metastasis | 25 (89%) | 17 (85%) | 42 | 0.68 | |
Nephrectomy side | Right | 16 (57%) | 10 (50%) | 26 | 0.88 |
Left | 9 (32%) | 9 (45%) | 18 | ||
Bilateral | 1 (3.6%) | 0 (0%) | 1 | ||
Other metastasis localisation, n | 18 (64%) | 15 (75%) | 33 | 0.43 |
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Taha, F.; Rhaiem, R.; Larre, S.; Kianmanesh, A.R.; Renard, Y.; Acidi, B. Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review. J. Clin. Med. 2025, 14, 7189. https://doi.org/10.3390/jcm14207189
Taha F, Rhaiem R, Larre S, Kianmanesh AR, Renard Y, Acidi B. Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review. Journal of Clinical Medicine. 2025; 14(20):7189. https://doi.org/10.3390/jcm14207189
Chicago/Turabian StyleTaha, Fayek, Rami Rhaiem, Stephane Larre, Ali Reza Kianmanesh, Yohan Renard, and Belkacem Acidi. 2025. "Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review" Journal of Clinical Medicine 14, no. 20: 7189. https://doi.org/10.3390/jcm14207189
APA StyleTaha, F., Rhaiem, R., Larre, S., Kianmanesh, A. R., Renard, Y., & Acidi, B. (2025). Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review. Journal of Clinical Medicine, 14(20), 7189. https://doi.org/10.3390/jcm14207189