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Review

Renal Cell Carcinoma with Duodenal Metastasis: Is There a Place for Surgery? A Review

1
Département d’Urologie, Centre Hospitalo-Universitaire de Reims, 45 rue Cognac Jay, 51092 Reims Cedex, France
2
Département de Chirurgie Viscérale et Endocrinienne, Centre Hospitalo-Universitaire de Reims, 45 rue Cognac Jay, 51092 Reims Cedex, France
3
Département de Chirurgie Oncologique, Institut Gustave Roussy, 114 Avenue Paul Vaillant Couturier, 94804 Villejuif Cedex, France
4
INSERM, Unit 1193, 94800 Villejuif, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(20), 7189; https://doi.org/10.3390/jcm14207189
Submission received: 7 August 2025 / Revised: 20 September 2025 / Accepted: 26 September 2025 / Published: 12 October 2025
(This article belongs to the Special Issue Renal Cell Carcinoma: From Diagnostic to Therapy)

Abstract

Introduction: Renal cell carcinoma (RCC) develops metastatic disease in 30–50% of patients during their disease course, with approximately one quarter presenting with metastases at diagnosis. While the lungs, liver, bones, brain, and adrenal glands are the most frequent metastatic sites, duodenal involvement is exceptionally rare. This uncommon presentation poses diagnostic and therapeutic challenges, particularly regarding the role of surgical resection in the metastatic setting. Objective: We aim to evaluate the clinical presentation, management strategies, and outcomes of patients with duodenal metastasis from RCC, with particular emphasis on the potential role of surgery, through a systematic review of the literature. Methods: A comprehensive electronic search of Medline, Embase, and Scopus was conducted according to PRISMA guidelines. The following MeSH terms were applied: Kidney Neoplasms [MeSH] AND Duodenal Neoplasms/metastasis [MeSH]. Eligible studies included original reports or case series describing RCC with duodenal metastasis. Demographic, clinical, surgical, and survival data were extracted and synthesized. Results: Of 89 records identified, 83 underwent full-text review and 51 met inclusion criteria, representing 55 patients. The median age at diagnosis was 64 years, and 80% of primary tumors arose from the right kidney. Nearly all patients (98%) were symptomatic, most commonly with upper gastrointestinal bleeding, anemia, or obstructive features. Pancreaticoduodenectomy was the predominant surgical approach, performed with curative intent in selected cases. Patients undergoing surgery achieved a 5-year overall survival of 70%, compared with 0% among non-operated patients. Conclusions: Duodenal metastasis from RCC remains an uncommon entity, limiting the strength of available evidence. Nevertheless, our findings suggest that surgical management—when feasible and decided within a multidisciplinary framework—can provide meaningful survival benefit and should be considered as a complement to contemporary systemic therapies for metastatic RCC

1. Introduction

Renal cell carcinoma (RCC) represents approximately 2–3% of all adult malignancies and is characterized by a wide spectrum of clinical behavior. Despite advances in imaging and earlier detection, 30–50% of patients develop metastatic disease during their disease course. More than 20% of patients will develop metastasis after curative-intent nephrectomy, underscoring the systemic nature of the disease even when initially localized. In addition, 20–30% of cases are diagnosed de novo at a metastatic stage [1].
According to French and European guidelines, surgical resection of metastases (metastasectomy) should always be considered when technically and oncologically feasible, as it has been associated with improvement in overall survival, particularly in the setting of oligometastatic disease [1,2]. This approach is supported by retrospective series and selected prospective data, which suggest that complete resection of limited metastatic deposits may offer prolonged disease control and, in some cases, durable remission.
The most frequent metastatic sites for RCC include the lung, liver, bone, brain, and adrenal gland. Interestingly, RCC exhibits unique metastatic patterns compared with other solid tumors, including a well-documented tropism for the pancreas. RCC has been cited as the most common primary tumor leading to solitary pancreatic metastasis, whereas duodenal metastasis remains distinctly uncommon. Autopsy series indicate that RCC accounts for approximately 7% of all metastatic lesions identified in the small bowel [3], suggesting that the true incidence may be underestimated during life due to the often nonspecific or silent presentation of such lesions.
Duodenal metastases, when encountered, most frequently originate from melanoma, lung cancer, breast cancer, or thyroid cancer [4,5], Metastatic spread from RCC to the duodenum is therefore unusual and may present diagnostic and therapeutic challenges, particularly because symptoms—when present—tend to be nonspecific, including anemia, gastrointestinal bleeding, or obstructive phenomena. While sporadic case reports have described duodenal involvement by RCC, the literature remains fragmented, and, to date,, no systematic review has been recently published on this specific metastatic site.
Here, we systematically compile and analyze all published cases of duodenal metastasis from RCC to describe patient and tumor characteristics, evaluate management strategies and outcomes, and assess the specific role and potential benefits of surgical intervention.

2. Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement guidelines were followed throughout the entire process to ensure methodological transparency and reproducibility [6]. A comprehensive electronic search was carried out to identify all published studies from January 1995 to January 2021. The Medline, Embase, and Scopus databases were selected as they represent the most widely used and complementary biomedical sources, covering both clinical and surgical literature. The following combination of keywords was used to identify relevant studies: (“Kidney Metastasis” OR “Carcinoma, renal cell”) AND (“duodenum” OR “duodenum metastasis”). In addition to database searching, the reference lists of all selected papers were manually screened to identify potential additional studies not captured during the initial search strategy.
Studies were included if they contained original data on patients diagnosed with duodenal metastasis from RCC. Review articles without original patient data, editorials, and duplicated data across publications were excluded. Only articles published in English were selected for analysis to ensure accurate interpretation of clinical and surgical details.
The screening process was performed in two distinct stages. First, titles and abstracts were independently reviewed by two trained reviewers to assess preliminary eligibility. Any disagreement at this stage was resolved through discussion with two senior reviewers. Second, the full-text versions of all shortlisted studies were obtained and assessed for final inclusion or exclusion by two independent researchers using the same consensus process. Data extraction was then performed independently by the reviewers, and any discrepancies were resolved by agreement or by referral to the two senior authors. In cases where data were incomplete or missing, attempts were made to contact the corresponding author (when contact information was available in the article) to obtain additional details.
From each eligible study, the following data were collected:
(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.
For statistical analysis, patients were classified into two groups: those who underwent surgery and those managed without surgical resection. Comparisons between groups were performed using the Mann–Whitney test for continuous variables and Fisher’s exact test or Chi-square test for categorical variables. Survival analyses were performed using the Kaplan–Meier method with available outcome data on overall survival, and survival curves were compared using the log-rank test.

3. Results

3.1. Data Extraction

A total of 89 articles were initially identified through the database search. After removing duplicates and applying the initial screening process, 83 full-text articles were assessed for eligibility. Following the application of predefined inclusion and exclusion criteria, 51 articles were ultimately included, representing 55 individual patients diagnosed with duodenal metastasis from RCC (Figure 1: flow chart).
The rarity of eligible cases illustrates the uncommon nature of this condition and explains why most available evidence is limited to isolated case reports or small series. To ensure transparency, all patient-level data extracted from the included studies are detailed in Table 1. For clarity and synthesis, overall cohort characteristics were pooled and summarized in Table 2, which reports mean values and proportions together with their 95% confidence intervals.

3.2. Haracteristics of Patients

The mean age at diagnosis of duodenal metastasis was 64 years, and the sex ratio was markedly in favor of males, with a male-to-female ratio of 4:1. Most of the metastases were metachronous, occurring in 49 patients after an initial disease-free interval. Among patients with synchronous metastases, the average disease-free interval (DFI) was 7 years, ranging widely from as short as 8 months to as long as 33 years after the primary nephrectomy.
Concomitant metastatic sites were present in 20 patients (36%), underlining the systemic nature of advanced RCC in a significant proportion of cases. Regarding the primary tumor, the right kidney was identified as the origin in 28 patients (58%). The duodenal metastatic site most frequently involved was the second portion of the duo-denum, which was affected in 35 patients (80%). Within this subgroup, 12 patients (27%) had a peripapillary localization, a finding with potential implications for biliary and pancreatic duct involvement.

3.3. Clinical Presentation

A wide spectrum of clinical presentations was observed, as detailed in Table 2. Overall, duodenal metastases were symptomatic in 54 of the 55 patients (98%), indicating that incidental detection was exceptional. The most frequent initial presentation was gastrointestinal bleeding, which was reported in 36 patients (65%). This bleeding was either manifested as upper gastrointestinal hemorrhage (12 patients, 22%) or as melena and/or hematochezia (26 patients, 47%). Anemia, often secondary to chronic blood loss, was documented in 32 patients (58%). These findings emphasize that digestive bleeding and related anemia are the dominant modes of presentation in this rare metastatic setting.

3.4. Complementary Exams

A CT scan was performed in 39 patients (71%), providing the first morphological assessment of duodenal involvement. Among these, 27 patients (69%) demonstrated either a duodenal mass or focal wall thickening, typically with the classical radiological appearance of a hypervascularized lesion. Biliary duct dilatation was reported in 6 cases (15%), reflecting the potential for secondary obstruction. Notably, in 5 patients (12%), CT failed to reveal any abnormality in the duodenum or pancreas, underlining the possibility of false-negative results and the limits of cross-sectional imaging in this context.
Endoscopic examination was conducted in 51 patients (91%) and offered complementary diagnostic information. The most frequent finding was a submucosal mass, often ulcerated or actively bleeding, consistent with the vascular nature of RCC metastases. In a minority of patients (8%), the only abnormality was a solitary ulcer without an obvious mass, emphasizing the heterogeneity of mucosal involvement and the importance of obtaining biopsies in any suspicious lesion in patients with a prior history of RCC

4. Treatment and Outcome

4.1. Treatment Strategy

Therapeutic management was reported in 48 patients. Surgery alone was performed in 23 patients (48%), while 5 patients (10%) received a combination of surgery and systemic therapy. Eleven patients (23%) were managed with medical treatment alone, the most frequent regimen being antiangiogenic therapy, which was used in 61% of cases receiving systemic treatment.
In the specific context of non-controlled tumor bleeding, different approaches were adopted. One patient underwent urgent surgical pancreaticoduodenectomy, while another was treated with endoscopic thermocoagulation. However, the most commonly used hemostatic intervention was radiological embolization, performed in 3 patients.
In case of non-controlled tumor bleeding: a surgical treatment with pancreaticoduodenoctomy was performed in one patient, and endoscopic thermocoagulation in one other patient. But the most used hemostatic procedure was radiological embolization performed in 3 patients.

4.2. Surgical Procedure Outcomes and Comparison with Non Surgical Procedure Management

Among surgical patients, the most frequent procedure was pancreaticoduodenectomy, performed in 20 cases (76%). Other surgical approaches included wedge resection or more limited procedures such as ampullectomy in 6 patients (24%). Early postoperative outcomes were reported in 23 patients. Major complications (Clavien–Dindo grade ≥ III) occurred in three cases: two patients developed an anastomotic leak, and one patient died on postoperative day 40 from sepsis or bleeding. Additionally, two patients experienced postoperative gastroplegia. Of the operated cohort, 7 patients (26%) were noted to have other suspected metastatic sites at the time of surgery, and in two cases local treatment of these additional sites was undertaken simultaneously (Table 3).
When comparing surgical to non-surgical management, operated patients showed markedly improved survival (Figure 2). The 5-year overall survival rate reached 70% in the surgical cohort, whereas no long-term survivors were reported among patients managed without surgery. While these results highlight the potential benefit of resection, they must be interpreted cautiously given the high risk of selection bias and the limited number of cases.

5. Discussion

5.1. Features of Duodenal Metastases

The dissemination of renal cell carcinoma (RCC) to the duodenum can occur through several mechanisms, including hematogenous spread, lymphatic dissemination, transcoelomic seeding, or direct invasion from the primary tumor. Among these, direct invasion appears to be the most frequent pathway, a finding that can be largely attributed to the close anatomical relationship between the right kidney and the duodenum. This observation is consistent with the predominance of right-sided primaries reported in the included studies, suggesting that anatomical proximity plays a central role in this metastatic pattern.
Nevertheless, the presence of metachronous lesions, sometimes occurring several years after nephrectomy, indicates that hematogenous dissemination may also be a relevant mechanism in selected cases. This highlights the biological heterogeneity of RCC and its well-known ability to generate late and unusual metastatic deposits.
In metachronous presentations, an interesting but unanswered question is whether the status of surgical margins following nephrectomy could be associated with the later occurrence of duodenal metastases. Unfortunately, none of the articles reviewed provided details on margin status, preventing further exploration of this hypothesis.
From a clinical standpoint, symptoms were present in 98% of patients, and in most cases these were related to gastrointestinal bleeding. Presentations ranged from occult bleeding with anemia to massive hemorrhage requiring emergency hemostatic intervention. The high incidence of bleeding can be explained by the typical hypervascularization of renal cell carcinoma lesions.
From a diagnostic perspective, CT scans failed to show any abnormality in 12% of cases, highlighting the crucial role of endoscopic examination. While the endoscopic presentation most frequently consists of a mass or polypoid lesion, in some patients only an ulcer is observed. This underlines the importance of performing biopsies in any suspicious lesion in patients with a prior history of cancer. The case report by Chara et al. [26] illustrates the consequences of a missed opportunity: an ulcer was not biopsied, leading to a delayed diagnosis.

5.2. Role of Metastasectomy in Oligometastatic Renal Cell Carcinoma

Up to now, it is considered that any patient with solitary metastatic RCC should be a candidate for a complete surgical excision if medical and technically possible according to European and French guidelines [1] even if no prospective randomized clinical trials have been realized so far. Indeed, those recommendations are based on retrospectives studies. We can notice that the utilization of metastasectomy increased from 24.9% in 2006 to 31,4% in 2013 [57].
In the review of Dabestani et al. [58], complete metastasectomy was associated with significantly longer survival rates in median of medians (OS or CSS) 40.8 [31.6–48.0] vs. 14.8 months [13.2–21 months] compared with incomplete or no metastasectomy.
Candidate patients for metastasis resection must be selected according to specific criteria, according to the multiple reviews [59,60,61]: Age, performance status, favorable MSKCC, high DFI, low metastatic volume.
In metastasectomy of RCC, intraoperative complications and major complications (Clavien III–IV) were found in 7.9 and 25.1% of patients, respectively, with in-hospital mortality rate of 2.4% [62].
Pancreas metastases are similar to duodenal metastases in some points, especially for surgery technique. A recent meta-analysis of 354 patients with pancreatic metastases showed a 5-year overall survival of 53.9% for patients who had surgical resection of pancreatic tumors secondary to RCC [63]. Pancreaticoduodenectomy was performed in 119 patients.
In their review, Hall et al., defined criteria for patients who should be candidate for surgery in case of pancreatic metastases [59]:
-
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

Our review, which includes all published cases over the last 25 years, suggests that patients undergoing surgical resection have a better survival prognosis. However, the data remain insufficient to draw firm conclusions, mainly because of several biases, including publication bias and selection bias in survival analyses. In contrast to pancreatic metastases, which are symptomatic in only 45% of patients [64] duodenal metastases are symptomatic in nearly all reported cases. The standard surgical approach for duodenal metastases is classical pancreaticoduodenectomy, although wedge or partial resections may be performed in selected cases. This differs from pancreatic metastases, where pancreaticoduodenectomy is less frequently performed and other, more limited resections are often possible [27].
Unlike pancreatic metastases from RCC, which are associated with comparatively favorable survival outcomes, no similar prognostic advantage has been demonstrated for duodenal metastases, underlining the distinct and less favorable nature of this metastatic site.
Of course, when metastatic sites are multiples and diffused, introduction of targeted therapy must be indicated. Moreover, currently we have a lot of new drugs available for treatment of metastatic renal cancer with proved efficiency, and arrival of immunotherapy checkpoint inhibitors has changed the medical strategy in medical treatment of metastatic RCC [1]. One potential advantage of metastasectomy, when feasible, is the possibility of delaying systemic therapy, thereby postponing the exposure to drug-related toxicities.However, the interpretation of these findings must take into account several limitations. Beyond publication and selection biases, data on disease-free survival (DFS), were inconsistently reported across case reports. This heterogeneity precluded any reliable pooled analysis and represents an additional limitation of the present review.
A major limitation of the present review is the inherent risk of publication bias, since positive outcomes are more likely to be reported, and selection bias, as patients offered surgery are usually younger, fitter, and with more favorable disease characteristics. These factors must be taken into account when interpreting the apparent survival advantage associated with surgical management.
When resection is not possible for a symptomatic tumor, palliative treatments may be appropriate. Some authors have reported successful embolization of RCC duodenal metastases to control persistent bleeding. For biliary obstruction, endoscopic placement of a stent may be indicated [65].
Finally, a few cases have also been treated with radiotherapy, though the evidence remains anecdotal, and its role is not well established in this context.

6. Conclusions

The clinical features of duodenal metastases from renal cell carcinoma (RCC) are largely similar to those of primary duodenal tumors, with the notable exception of a higher propensity for significant bleeding, likely due to the marked hypervascularization characteristic of RCC. In nearly all reported cases, duodenal metastases are symptomatic at the time of diagnosis.
Imaging and endoscopy are useful diagnostic tools, but histological confirmation remains mandatory. Immunohistochemistry plays a crucial role in establishing the renal origin of the lesion and distinguishing it from other primary or secondary tumors.
Although the number of reported cases is low, and most publications include only one or two patients, the available evidence suggests that duodenal metastasis represents a poor prognostic location, mainly due to its local complications. The rarity of this condition precludes large-scale series, introducing potential biases such as publication and selection bias that may overestimate the apparent benefit of surgery.
By analogy with other oligometastatic RCC sites, surgical resection should be considered within a multidisciplinary tumor board, but decisions must take into account patient-specific factors and the feasibility of complete resection. For non-resectable but symptomatic tumors, palliative approaches such as embolization or stenting may provide effective symptom control.
Finally, systemic therapy remains a cornerstone of management in metastatic RCC. The rapid evolution of targeted agents and immune checkpoint inhibitors is reshaping treatment paradigms and will likely redefine the role of metastasectomy in carefully selected patients over the coming decade.

Author Contributions

Conceptualization, B.A. and F.T.; methodology, B.A.; software, B.A.; validation, B.A., F.T. and Y.R.; formal analysis, B.A.; investigation, F.T. and B.A.; resources, A.R.K. and S.L.; data curation, R.R. and B.A.; writing—original draft preparation, B.A.; writing—review and editing, F.T., Y.R., R.R., A.R.K., S.L. and B.A.; visualization, B.A.; supervision, A.R.K. and S.L.; project administration, B.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Ljungberg, B.; Albiges, L.; Abu-Ghanem, Y.; Bensalah, K.; Dabestani, S.; Fernández-Pello, S.; Giles, R.H.; Hofmann, F.; Hora, M.; Kuczyk, M.A.; et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur. Urol. 2019, 75, 799–810. [Google Scholar] [CrossRef] [PubMed]
  2. Rouprêt, M.; Audenet, F.; Roumiguié, M.; Pignot, G.; Masson-Lecomte, A.; Compérat, E.; Houédé, N.; Larré, S.; Brunelle, S.; Xylinas, E.; et al. French ccAFU Guidelines—Update 2020–2022: Upper Urinary Tract Urothelial Carcinoma. Progres Urol. J. Assoc. Fr. Urol. Soc. Fr. Urol. 2020, 30, S52–S77. [Google Scholar] [CrossRef]
  3. Kanthan, R.; Gomez, D.; Senger, J.-L.; Kanthan, S.C. Endoscopic biopsies of duodenal polyp/mass lesions: A surgical pathology review. J. Clin. Pathol. 2010, 63, 921–925. [Google Scholar] [CrossRef] [PubMed]
  4. Iwamuro, M.; Okada, H.; Matsueda, K.; Inaba, T.; Kusumoto, C.; Imagawa, A.; Yamamoto, K. Metastatic tumors in the duodenum: A report of two cases. J. Cancer Res. Ther. 2015, 11, 639–641. [Google Scholar] [CrossRef] [PubMed]
  5. Espinoza, E.; Hassani, A.; Vaishampayan, U.; Shi, D.; Pontes, J.E.; Weaver, D.W. Surgical excision of duodenal/pancreatic metastatic renal cell carcinoma. Front. Oncol. 2014, 4, 218. [Google Scholar] [CrossRef] [PubMed]
  6. Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G.; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J. Clin. Epidemiol. 2009, 62, 1006–1012. [Google Scholar] [CrossRef]
  7. Black, J.A.; Mendelson, R.M. Duodenal haemorrhage resulting from renal cell carcinoma metastases. Australas. Radiol. 1995, 39, 396–398. [Google Scholar] [CrossRef]
  8. Hsu, C.C.; Chen, J.J.; Changchien, C.S. Endoscopic features of metastatic tumors in the upper gastrointestinal tract. Endoscopy 1996, 28, 249–253. [Google Scholar] [CrossRef]
  9. Leslie, K.A.; Tsao, J.I.; Rossi, R.L.; Braasch, J.W. Metastatic renal cell carcinoma to ampulla of Vater: An unusual lesion amenable to surgical resection. Surgery 1996, 119, 349–351. [Google Scholar] [CrossRef]
  10. Toh, S.K.; Hale, J.E. Late presentation of a solitary metastasis of renal cell carcinoma as an obstructive duodenal mass. Postgrad. Med. J. 1996, 72, 178–179. [Google Scholar] [CrossRef]
  11. Janzen, R.M.; Ramj, A.S.; Flint, J.D.; Scudamore, C.H.; Yoshida, E.M. Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: A diagnostic conundrum. Can. J. Gastroenterol. Hepatol. 1998, 12, 75–78. [Google Scholar] [CrossRef]
  12. Yavaşçaoğlu, I.; Korun, N.; Oktay, B.; Simşek, U.; Ozyurt, M. Renal cell carcinoma with solitary synchronous pancreaticoduodenal and metachronous periprostatic metastases: Report of a case. Surg. Today 1999, 29, 364–366. [Google Scholar] [CrossRef] [PubMed]
  13. Ohmura, Y.; Ohta, T.; Doihara, H.; Shimizu, N. Local recurrence of renal cell carcinoma causing massive gastrointestinal bleeding: A report of two patients who underwent surgical resection. Jpn. J. Clin. Oncol. 2000, 30, 241–245. [Google Scholar] [CrossRef] [PubMed]
  14. Hashimoto, M.; Miura, Y.; Matsuda, M.; Watanabe, G. Concomitant duodenal and pancreatic metastases from renal cell carcinoma: Report of a case. Surg. Today 2001, 31, 180–183. [Google Scholar] [CrossRef] [PubMed]
  15. Lee, J.G.; Kim, J.S.; Kim, H.J.; Kim, S.T.; Yeon, J.E.; Byun, K.S.; Kim, J.S.; Bak, Y.T.; Lee, C.H. Simultaneous duodenal and colon masses as late presentation of metastatic renal cell carcinoma. Korean J. Intern. Med. 2002, 17, 143–146. [Google Scholar] [CrossRef]
  16. Loualidi, A.; Spooren, P.F.M.J.; Grubben, M.J.A.L.; Blomjous, C.E.M.; Goey, S.H. Duodenal metastasis: An uncommon cause of occult small intestinal bleeding. Neth. J. Med. 2004, 62, 201–205. [Google Scholar]
  17. Chang, W.-T.; Lee, K.-T.; Chai, C.-Y. Unusual upper gastrointestinal bleeding due to late metastasis from renal cell carcinoma: A case report. Kaohsiung J. Med. Sci. 2004, 20, 137–141. [Google Scholar] [CrossRef] [PubMed]
  18. Bhatia, A.; Das, A.; Kumar, Y.; Kochhar, R. Renal cell carcinoma metastasizing to duodenum: A rare occurrence. Diagn. Pathol. 2006, 1, 29. [Google Scholar] [CrossRef] [PubMed]
  19. Sadler, G.J.; Anderson, M.R.; Moss, M.S.; Wilson, P.G. Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: Two case reports and a review of the literature. BMC Gastroenterol. 2007, 7, 4. [Google Scholar] [CrossRef]
  20. Adamo, R.; Greaney, P.J.; Witkiewicz, A.; Kennedy, E.P.; Yeo, C.J. Renal cell carcinoma metastatic to the duodenum: Treatment by classic pancreaticoduodenectomy and review of the literature. J. Gastrointest. Surg. 2008, 12, 1465–1468. [Google Scholar] [CrossRef]
  21. Das, K.K.; Dhar, V. Unremitting upper GI bleeding from a duodenal mass. Gastroenterology 2009, 137, 42–396. [Google Scholar] [CrossRef] [PubMed]
  22. Teo, M.; Ryan, B.; Swan, N.; McDermott, R.S. A Case of Metastatic Renal Cell Cancer Presenting as Jaundice. World J. Oncol. 2010, 1, 218–220. [Google Scholar] [CrossRef]
  23. He, X.; Lu, N.; Zhang, R.; Zhu, L. Duodenal metastases of renal cell carcinoma: A case report. Chin. Med. J. 2010, 123, 1228–1229. [Google Scholar] [PubMed]
  24. Rustagi, T.; Rangasamy, P.; Versland, M. Duodenal bleeding from metastatic renal cell carcinoma. Case Rep. Gastroenterol. 2011, 5, 249–257. [Google Scholar] [CrossRef] [PubMed]
  25. Cherian, S.V.; Das, S.; Garcha, A.S.; Gopaluni, S.; Wright, J.; Landas, S.K. Recurrent renal cell cancer presenting as gastrointestinal bleed. World J. Gastrointest. Oncol. 2011, 3, 99–102. [Google Scholar] [CrossRef] [PubMed]
  26. Chara, L.; Rodríguez, B.; Holgado, E.; Ramírez, N.; Fernández-Rañada, I.; Mohedano, N.; Arcediano, A.; García, I.; Cassinello, J. An unusual metastatic renal cell carcinoma with maintained complete response to sunitinib treatment. Case Rep. Oncol. 2011, 4, 583–586. [Google Scholar] [CrossRef]
  27. Yang, J.; Zhang, Y.-B.; Liu, Z.-J.; Zhu, Y.-F.; Shen, L.-G. Surgical treatment of renal cell carcinoma metastasized to the duodenum. Chin. Med. J. 2012, 125, 3198–3200. [Google Scholar]
  28. Mandal, A.; Littler, Y.; Libertiny, G. Asymptomatic renal cell carcinoma with metastasis to the skin and duodenum: A case report and review of the literature. BMJ Case Rep. 2012, 2012, bcr0220125764. [Google Scholar] [CrossRef]
  29. Zhao, H.; Han, K.; Li, J.; Liang, P.; Zuo, G.; Zhang, Y.; Li, H. A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma. World J. Surg. Oncol. 2012, 10, 199. [Google Scholar] [CrossRef]
  30. Chen, Y.C.; Yang, Y.C.; Li, M.H.; Kuo, H.C.; Lee, M.C. Complete metastasectomy to treat simultaneous metastases of the duodenum and pancreas caused by renal cell carcinoma. Tzu Chi Med. J. 2011, 24, 24–27. [Google Scholar] [CrossRef]
  31. Schlussel, A.T.; Fowler, A.B.; Chinn, H.K.; Wong, L.L. Management of locally advanced renal cell carcinoma with invasion of the duodenum. Case Rep. Surg. 2013, 2013, 596362. [Google Scholar] [CrossRef] [PubMed]
  32. Gonzalo-Marín, J.; Aguilar-Urbano, V.M.; Muñoz-Castillo, F.; Albandea-Moreno, C.; Montes-Aragón, C.; de-Sola-Earle, C. Upper gastrointestinal bleeding secondary to renal tumor. Rev. Esp. Enferm. Dig. 2012, 104, 614–615. [Google Scholar] [CrossRef] [PubMed]
  33. Vashi, P.G.; Abboud, E.; Gupta, D. Renal cell carcinoma with unusual metastasis to the small intestine manifesting as extensive polyposis: Successful management with intraoperative therapeutic endoscopy. Case Rep. Gastroenterol. 2011, 5, 471–478. [Google Scholar] [CrossRef]
  34. Teli, M.A.; Shah, O.J.; Jan, A.M.; Khan, N.A. Duodenal metastasis from renal cell carcinoma presenting as gastrointestinal bleed. J. Med. Sci. 2012, 15, 65–68. [Google Scholar] [CrossRef]
  35. Karakatsanis, A.; Vezakis, A.; Fragulidis, G.; Staikou, C.; Carvounis, E.E.; Polydorou, A. Obstructive jaundice due to ampullary metastasis of renal cell carcinoma. World J. Surg. Oncol. 2013, 11, 262. [Google Scholar] [CrossRef] [PubMed]
  36. Hata, T.; Sakata, N.; Aoki, T.; Yoshida, H.; Kanno, A.; Fujishima, F.; Motoi, F.; Masamune, A.; Shimosegawa, T.; Unno, M. Repeated pancreatectomy for metachronous duodenal and pancreatic metastases of renal cell carcinoma. Case Rep. Gastroenterol. 2013, 7, 442–448. [Google Scholar] [CrossRef] [PubMed]
  37. Neofytou, K.; Giakoustidis, A.; Gore, M.; Mudan, S. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis. Case Rep. Surg. 2014, 2014, 218953. [Google Scholar] [CrossRef]
  38. Haidong, W.; Jianwei, W.; Guizhong, L.; Ning, L.; Feng, H.; Libo, M. Ampullary tumor caused by metastatic renal cell carcinoma and literature review. Urol. J. 2014, 11, 1504–1507. [Google Scholar]
  39. Hu, J.; Wu, S.T.; Lin, Y.C.; Chang, H.M. Metachronous duodenal metastasis from renal cell carcinoma. J. Med. Sci. 2014, 34, 186–189. [Google Scholar]
  40. Mohamed, M.O.; Al-Rubaye, S.; Reilly, I.W.; McGoldrick, S. Renal cell carcinoma presenting as an upper gastrointestinal bleeding. BMJ Case Rep. 2015, 2015, bcr2015211553. [Google Scholar] [CrossRef]
  41. Vootla, V.R.; Kashif, M.; Niazi, M.; Nayudu, S.K. Recurrent Renal Cell Carcinoma with Synchronous Tumor Growth in Azygoesophageal Recess and Duodenum: A Rare Cause of Anemia and Upper Gastrointestinal Bleeding. Case Rep. Oncol. Med. 2015, 2015, 143934. [Google Scholar] [CrossRef]
  42. Geramizadeh, B.; Mostaghni, A.; Ranjbar, Z.; Moradian, F.; Heidari, M.; Khosravi, M.B.; Malekhosseini, S.A. An unusual case of metastatatic renal cell carcinoma presenting as melena and duodenal ulcer, 16 years after nephrectomy; a case report and review of the literature. Iran. J. Med. Sci. 2015, 40, 175–180. [Google Scholar] [PubMed]
  43. Jideh, B.; Chen, H.; Weltman, M.; Chan, C.H.Y. Metastatic periampullary clear cell renal carcinoma. Gastrointest. Endosc. 2016, 83, 1040–1042, discussion 1042. [Google Scholar] [CrossRef] [PubMed]
  44. Sarocchi, F.; Gilg, M.M.; Schreiber, F.; Langner, C. Secondary tumours of the ampulla of Vater: Case report and review of the literature. Mol. Clin. Oncol. 2018, 8, 274–280. [Google Scholar] [CrossRef] [PubMed]
  45. Saito, M.; Senjo, H.; Kanaya, M.; Izumiyama, K.; Mori, A.; Tanaka, M.; Morioka, M.; Miyashita, K.; Ishida, Y. Late duodenal metastasis from renal cell carcinoma with newly developed malignant lymphoma: A case report. Mol. Clin. Oncol. 2018, 8, 549–552. [Google Scholar] [CrossRef] [PubMed]
  46. Omranipour, R.; Mahmoud Zadeh, H.; Ensani, F.; Yadegari, S.; Miri, S.R. Duodenal Metastases from Renal Cell Carcinoma Presented with Melena: Review and Case Report. Iran. J. Pathol. 2017, 12, 272–276. [Google Scholar] [CrossRef] [PubMed]
  47. Villela-Segura, U.; García-Leiva, J.; Nuñez Becerra, P.J. Duodenal metastases from sarcomatoid renal cell carcinoma: Case report. Gastroenterol. Hepatol. 2017, 40, 530–532. [Google Scholar] [CrossRef] [PubMed]
  48. Podboy, A.; Shah, N. The Past Is Never Past: An Unusual Cause of Melena. Gastroenterology 2018, 155, e3–e4. [Google Scholar] [CrossRef]
  49. Ignatavicius, P.; Lizdenis, P.; Pranys, D.; Gulbinas, A.; Pundzius, J.; Barauskas, G. Long-term Survival of Patient with Ampulla of Vater Metastasis of Renal Cell Carcinoma. Prague Med. Rep. 2018, 119, 165–169. [Google Scholar] [CrossRef]
  50. Popović, I.; Muslim, A.; Jurčić, P.; Nikolic, M.; Budimir, I. Metastatic renal cell carcinoma as a rare cause of duodenal obstruction and gastrointestinal bleeding. Acta Med. Croat. 2018, 72, 351–353. [Google Scholar]
  51. Nakamura, T.; Oe, N.; Matsumori, T. A Hypervascular Mass at the Papilla of Vater. Gastroenterology 2019, 156, e7–e9. [Google Scholar] [CrossRef]
  52. Munir, A.; Khan, A.M.; McCarthy, L.; Mehdi, S. An Unusual Case of Renal Cell Carcinoma Metastasis to Duodenum Presenting as Gastrointestinal Bleeding. JCO Oncol. Pract. 2020, 16, 49–50. [Google Scholar] [CrossRef] [PubMed]
  53. Farrokh, D.; Rad, M.P.; Mortazavi, R.; Akhavan, R.; Abbasi, B. Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: Management with renal artery embolization. CVIR Endovasc. 2019, 2, 10. [Google Scholar] [CrossRef] [PubMed]
  54. Baghmar, S.; Shasthry, S.M.; Singla, R.; Patidar, Y.; Bihari, C.B.; Sarin, S.K. Solitary duodenal metastasis from renal cell carcinoma with metachronous pancreatic neuroendocrine tumor: Review of literature with a case discussion. Indian J. Med. Paediatr. Oncol. 2019, 40, S185–S190. [Google Scholar] [CrossRef]
  55. Jang, J.-H.; Kang, S.-B.; Lee, S.-M.; Park, J.-S.; Kim, D.-W.; Ahn, S. Randomized controlled trial of tamsulosin for prevention of acute voiding difficulty after rectal cancer surgery. World J. Surg. 2012, 36, 2730–2737. [Google Scholar] [CrossRef] [PubMed]
  56. Peters, N.; Lightner, C.; McCaffrey, J. An Unusual Case of Gastrointestinal Bleeding in Metastatic Renal Cell Carcinoma. Case Rep. Oncol. 2020, 13, 738–741. [Google Scholar] [CrossRef] [PubMed]
  57. Sun, M.; Meyer, C.P.; Karam, J.A.; de Velasco, G.; Chang, S.L.; Pal, S.K.; Trinh, Q.-D.; Choueiri, T.K. Predictors, utilization patterns, and overall survival of patients undergoing metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy. Eur. J. Surg. Oncol. 2018, 44, 1439–1445. [Google Scholar] [CrossRef] [PubMed]
  58. Dabestani, S.; Marconi, L.; Hofmann, F.; Stewart, F.; Lam, T.B.L.; Canfield, S.E.; Staehler, M.; Powles, T.; Ljungberg, B.; Bex, A. Local treatments for metastases of renal cell carcinoma: A systematic review. Lancet Oncol. 2014, 15, e549–e561. [Google Scholar] [CrossRef] [PubMed]
  59. Dr Hall, B.; Abel, E.J. The Evolving Role of Metastasectomy for Patients with Metastatic Renal Cell Carcinoma. Urol. Clin. N. Am. 2020, 47, 379–388. [Google Scholar] [CrossRef]
  60. Psutka, S.P.; Master, V.A. Role of metastasis-directed treatment in kidney cancer. Cancer 2018, 124, 3641–3655. [Google Scholar] [CrossRef]
  61. Apollonio, G.; Raimondi, A.; Verzoni, E.; Claps, M.; Sepe, P.; Pagani, F.; Ratta, R.; Montorsi, F.; De Braud, F.G.M.; Procopio, G. The role of metastasectomy in advanced renal cell carcinoma. Expert Rev. Anticancer Ther. 2019, 19, 603–611. [Google Scholar] [CrossRef]
  62. Meyer, C.P.; Sun, M.; Karam, J.A.; Leow, J.J.; de Velasco, G.; Pal, S.K.; Chang, S.L.; Trinh, Q.-D.; Choueiri, T.K. Complications After Metastasectomy for Renal Cell Carcinoma-A Population-based Assessment. Eur. Urol. 2017, 72, 171–174. [Google Scholar] [CrossRef]
  63. Jaen-Torrejimeno, I.; Rojas-Holguín, A.; López-Guerra, D.; Ramia, J.M.; Blanco-Fernández, G. Pancreatic resection for metastatic renal cell carcinoma. A systematic review. HPB 2020, 22, 479–486. [Google Scholar] [CrossRef]
  64. Cheng, S.K.H.; Chuah, K.L. Metastatic Renal Cell Carcinoma to the Pancreas: A Review. Arch. Pathol. Lab. Med. 2016, 140, 598–602. [Google Scholar] [CrossRef]
  65. Lynch-Nyhan, A.; Fishman, E.K.; Kadir, S. Diagnosis and management of massive gastrointestinal bleeding owing to duodenal metastasis from renal cell carcinoma. J. Urol. 1987, 138, 611–613. [Google Scholar] [CrossRef]
Figure 1. Flow chart.
Figure 1. Flow chart.
Jcm 14 07189 g001
Figure 2. Overall Survival.
Figure 2. Overall Survival.
Jcm 14 07189 g002
Table 1. Summary of all published cases of duodenal metastases of Renal Cell Carcinoma.
Table 1. Summary of all published cases of duodenal metastases of Renal Cell Carcinoma.
Ref.Gender, AgeClinical
Presentation
Biological
Abnormalities
CT SCANEndoscpîc
Aspect/Localisation
Histological Proof of
Renal
Carcinoma
Nephrectomy SideDelay After
Nephrectomy
Treatment Patient OutcomeOther
Localization
Operated
Patients-
Complications
Black, 1995 [7]F, 60 yearsMelenaSevere anemiaMass invading pancreasPeriampullary lesionSurgical sampleRightMetachronous-6 yearsSurgery -
Hsu, 1996 [8]F, 54 yearsMelena, anemiaAnemia-Second duodenum-polypoid massEndoscopic biopsy-Metachronous-1.5 yearsChemotherapyDead at 1 month-
Hsu, 1996 [8]F, 72 yearsMelena, anemiaAnemiaLocalized right renal tumorSecond duodenum-Submucosal mass with ulcerationsEndoscopic biopsyLeftMetachronous-1 yearTreatment refusedLost to follow upBone
Leslie, 1996 [9]M, 53 yearsMelena, weight lossBilirubin increase Periampullary lesionEndoscopic biopsyRightMetachronous 8 yearsPDAlive at 2.5 years -No complication
Toh, 1998 [10]F, 59 yearsLethargy, abdominal pain, anorexia, weight loss, iron suplementation for chronic anemiaAnemiaSolid mass on the posterior wall of DuodenumNormalSurgical sampleRightMetachronous-10 yearsWedge resection--Gastroplegia
Janzen, 1998 [11]M, 75 yearsMelena, bleeding necessitating ressucitation Severe anemiaPerimapullary mass extending to head of the pancreasPeriampullary mass Endoscopic biopsyLeftMetachronous-18 years -
Yavascaoglu, 1999 [12]M, 63 yearsRight flank pain, melena-Right renal tumor of 15 × 14 cm and pancreatico-duodenal mass 7 × 5 cmHemorrhagic area on the second duodenumEndoscopic biopsyRightSynchronousPD + interferon-NephrectomyAlive at 23 months--
Ohmura, 2000 [13]M, 62 yearsOcclusion Enhanced mass of renal fossa invading psoas muscle and duodenumLarge elvated irregular shaped tumor, obstructiveSurgical sampleLeftMetachronous-5 years Wedge resectionDead at 1 monthLung (surgery)Peritonitis/bleeding at day-40: death
Hashimoto, 2001 [14]M, 68 yearsDyspneaSevere anemiaWall thickeningUlcerated tumor on duodenal bulbSurgical sampleLeftMetachronous-11 yearsPDAlive at 18 months-No complication
Lee, 2002 [15]F, 76 yearsDyspepsia, abdominal pain, lump on upper right abdomen -Wall thickening Endoscopic biopsy LeftMetachronous-4 yearsMedical treatmentAlive at 1 year-
Loualidi, 2004 [16]M, 76, yearsWeakness, dizziness, dyspnea, epigastric discomfortAnemia-Periampullary–lobular massEndoscopic biopsy RightMetachronous-5 years Paliative radiotherapyAlive at 1 yearL5
Chang, 2004 [17]F, 63 years4 episodes of bleeding in 9 monthsSevere anemia-Duodenal bulb-ulcerative massEndoscopic biopsy RightMetachronous-9 yearsSurgeryAlive at 10 months-No complication
Bhatia, 2006 [18]M, 55 yearsJaundice, abdominal lumpCytolysis, cholestasisNo massSecond duodenum-submucosal lesionEndoscopic biopsyLeftMetachronous-1 yearPaliative radiotherapyLost to follow upLiver
Sadler, 2007 [19]M, 67 yearsMelaena, lethargyy, recurent anemia ++Severe anemiaPolypoid mass, in the medial wall of D2 arising from pancreas & renal massAngulus-polypEndoscopic biopsy LeftSynchronousNephrectomy + interferonDead 2 yearsLung & adrenal gland left
Sadler, 2007 [19]M, 75 yearsChronic anemia-Pancreatic mass invading duodenumDuodenal bulb-polypEndoscopic biopsy RightMetachronous-9 yearsNo treatment--
Adamo, 2008 [20]M, 86 yearsObstruction & anemia-Duodenal mass invading pancreas-Surgical sample-Metachronous-13 yearsPDAlive at 7 months-Pulmonary embolism
Das, 2009 [21]M, 68 yearsHematocheziaAnemia-Second duodenum-large friable, centrally ulcerated massEndoscopic biopsy-Metachronous-10 yearsPDAlive at 4 monthsLung
Teo, 2010 [22]M, 50 yearsJaundice, abdominal painCholestasis, cytolysis, bilirubin increase Dilatation of the biliary ductperiampullary-massEndoscopic biopsyLeftMetachronous-3 yearsAntiangiogenics1 weekLung
Kanthan, 2010 [3]M, 69 yearsUpper gastrointestinal bleeding---Endoscopic biopsy-Metachronous-8 years---
HE, 2010 [23]M, 62 yearsMassive melenaAnemia, elevated CA 19-9 and ACESubmucous tumorBleeding mass second duodenumSurgical sampleRightMetachronous-11 yearsPDAlive at 17 months-Gastroplegia
Rustagi, 2011 [24] M, 66 yearsMelena, anemia, fatigueSevere anemiaMassSecond duodenum-actively bleeding and ulcerative massEndoscopic biopsyBilateralMetachronous-13 yearsPDDead at 2 weeks-Leakage of pancreaticojejunostomy fistula-sepsis
Cherian, 2011 [25]M, 80 yearsSyncope, melenaSevere anemiaSoft tissue mass extending in duodenum from right nephrectomy bedSecond duodenumEndoscopic biopsyRightMetachronous-1 yearsSorafenib, everolimusDead at 1 yearLumbar vertebra-lung
Chara, 2011 [26]M, 49 yearsMelena Enlargement of the head of the pancreasDuodenal ulcer initially treated by sclerotherapy and biopsied 5 months after diagnosisSurgical sampleLeftMetachronous-6 yearsPDAlive at 4 years-No complication
Yang, 2012 [27]F, 72 yearsMelena, fatigue, hematemesisSevere anemia-Mass at second portion of duodenum bleeding and necrosisSurgical sampleLeftMetachronous-10 yearsWedge resectionRecurrence at 10 months-Surgical site infection-Pulmonary infection
Mandal, 2012 [28]F, 60 yars Melena-diarrheaNothingNo lesion on CT ScanSecond duodenum-abnormal duodenal borderEndoscopic biopsy LeftSynchronousNephrectomy + chemotherapy-Skin
Zhao, 2012 [29]M, 56 yearsOcclusion-bleeding-fatigueSevere anemiafilling defect Second duodenum-ulcerated and hemorrhagic massEndoscopic biopsyRightMetachronous-7 yearsWedge resectionAlive at 1.5 yearsTail pancreatic lump non operatedNo complication
Chen, 2012 [30]F, 76 yearsHematoschzia, anemiaAnemiaHypervascular lesion involving duodenum, pancreas gastric antrumFirst duodenum-submucosal mass involving stomachSurgical sampleLeftMetachronous-6 yearsPDAliver at 24 months-No complication
Schlussel, 2012 [31]M, 53 yearsMelana, fatigue,Severe anemiaLarge mass (15 cm) arising of right kidney protruding into duodenum lumenSecond duodenum -bleeding massSurgical sampleRightSynchronousNephrectomy + PD + thrombectomy + IL-2Alive at 3 monthsLungNo complication
Gonzalo-Marin, 2012 [32]M, 66 yearsMelenaAnemiaNecrotic right renal mass with duodenum invasion-bile duct dilatationSecond duodenum-large and deep ulceration with edematous bordersEndoscopic biopsyRightMetachronous--Paraaortic LN-lUng-
Vashi, 2012 [33]M, 53 yearsDyspneaSevere anemiaRight renal lesion First duodenum-2 small vascular polypsEndoscopic biopsyRightMetachronousDuodenotomy Small intestine polypsNo complication
Ashraf Teli, 2012 [34]M, 52 yearsGastro intestinal bleeding Duodenal metastasisDuodenal mass, bleedingSurgical sampleRightMetachronous-8 yearsDuodenotomyDied at 4 months-No complication
Karakatsanis, 2013 [35]M, 77 yearsIsolated jaundice-Dilatation of the biliary ductAmpula-massI25Endoscopic biopsy RightMetachronous-3 yearsAmpullectomy + biliary stentDead at 1.5 yearLung/bone
Hata, 2013 [36]M, 50 yearsAnemia, melenaSevere anemia Second duodenum-Ulcerated polypoid mass (not involving ampulla); NBIde,se assembly of microvesselsEndoscopic biopsy LeftMetachronous-15 yearsPDAlive at 1 yearBone (radiotherapy)-pancreas tail (surgery)Leakage of gastrojejunostomy
Neofytou, 2014 [37]M, 41 yearsMassive GI bleedingAnemia-Vater ampulaEndoscopic biopsy LeftMetachronous-1 yearInitially under pazopanib, PD for emergencyDead at 2 monthsAdrenal gland bilatera, thoracic lymphnodes
Espinoza,2014 [5]M, 58 yearsGastro intestinal bleeding----RightMetachronous-12 yearsPDAlive at 12 months-
Espinoza,2014 [5]F, 66 yearsAbdominal pain----RightMetachronous-4 yearsPDAlive at 12 months-
Haidong, 2014 [38]M, 50 yearsFatigue–fever– diarrheaBilirubin increase-Cholestasis- moderate cytolysisPresence of tumorNo endoscopySurgical sampleRightSynchronousPD + Radical nephrectomy FN alph-2bAlive at 5 years-No complication
Hu, 2014 [39]M, 57 yearsDyspnea, dyspepsia, fatigue, anemia, melenaSevere anemiaIntraluminal enhancing lesion 6 cmBulb/second duodenum-polypoid ulcerative and friable mass bleeding with obstructionEndoscopic biopsyRightMetachronous-12 yearsPD + sunitinibAlive at 6 months-No complication
Osama Mohamed, 2015 [40]M, 80 yearsMelena, abdominal pain, dyspneaAnemia8 cm mass lower pole of kidney invading duodenumpolypoidal mass anterior second duodenum bleeding-RightSynchronousPalliative treatment--
Vootla, 2015 [41]M, 74 yearsMelena, weight lossAnemia Duodenal noduleEndoscopic biopsyLeftMetachronous-4 yearsPaliative radiotherapy-Oesophagus
Geramizadeh, 2015 [42]M, 61 yearsMelenaNormalMass invading duodenum and pancreasSecond duodenum-ulcer aspectEndoscopic biopsyRightMetachronous-16 yearsPD -No complication
Jideh, 2016 [43]M, 50 yearsFever-abdominal pain-jaundiceBilirubin increase-cholestasisBiliary duct dilatation-no mass shownPeriampullary-mucosal massEndoscopic biopsyRight Metachronous ---
Sarocchi, 2016 [44]M, 57 yearsGI bleeding Vater ampula irregularEndoscopic biopsyLeftMetachronous-3.5 yearsPDAlive a 4 years-No complication
Saito, 2017 [45]M, 64 yearsAbdominal pain, fever, anorexia, weight loss-Hypervaslucar lesion duodenum and pancreatic headSecond duodenum apart form apula-submucosal mass with central ulcerEndoscopic biopsyLeftMetachronous-25 yearsPazopanib-Concomitant lymphoma treated-lung
Omranipour, 2017 [46]M, 59 yearsMelenaAnemiaMass in nephrectomy bed invading D2 and D3Irregular, polypoid, ulcerative mass in second portion of duodenumEndoscopic biopsyRightMetachronous-6 yearsPDAlive a 1 year-No complication
Villela-Segura, 2018 [47]F, 48 yearsBurning and sharp epigastric pain, hematemesis, melena, fever, hypotensionSevere anemiaMass in the second portion of duodenumMass at second portion of duodenum, submucosal, ulcerated surface, bleeding, 90% of stenosisEndoscopic biopsy-Metachronous-1 year-Dead at 1 week-
Podboy, 2018 [48]M, 80 yearsMelena-Hypervascularized mass of pancreas and duodenumUlcerated massEndoscopic biopsy-Metachronous-15 years---
Ignatavicius, 2018 [49]M, 62 yearsSevere upper abdominal pain, jaundice, lethargy, subclinical obstructionBilirubin increasePeriampummary mass, pancreatic and bile duct dilatationTumor at paiplla Surgical sampleLeftMetachronous-8 monthsPDDead at 14 months-No complication
Popovic, 2018 [50]M, 58 yearsOcclusion-bleeding Anemia Third duodenum-obstructive massEndoscopic biopsyLeftMetachronous-7 monthsEndoscopic thermocoagulationDead at 4 years-
Nakamura, 2019 [51]M, 74 yearsVomiting, orthostatic faintingSevere anemiaEUS: biliary duct dilatation and hypoechogenic mass EUS biopsyRightMetachronous---No complication
Munir, 2019 [52]M, 76 yearsAsymptomatic-diagnosis at following-MassSecond duodenum-friable massEndoscopic biopsyRightMetachronous-2 yearsSunitinib-nivolumab--
Farrokh, 2019 [53]M, 62 yearsFatigue, weigh loss, massive gastrointestinal bleeding Mass in nephrectomy bed invading D2 and D3Second duodenum-irregular ulcerative massEndoscopic biopsyRightMetachronous-10 yearsEmbolization-axitinib--
Baghmar, 2019 [54]M, 84 yearsFatigue, anemia, diarrhea Severe anemiaMass with central necrosisFirst/second duodenum junction-ulcerationsEndoscopic biopsyRightMetachronous-37 yearsPalliative treatment -
Jain, 2020 [55]M, 73 yearsAbdominal pain, nausea, vomiting, weight loss, hypertension, abdominal tenderness, anemiaSevere anemiaLymph nodes in pancreaticoduodenal, para-aortic, precaval regionsPeriampullary-ulcerEndoscopic biopsyRightMetachronous-33 yearsImmunotherapy-LN-
Peters, 2020 [56]M, 68 yearsDyspnea, fatigue, anemiaSevere anemia-Second duodenum-polypEndoscopic biopsyRightMetachronous-1.5 yearsEmbolization-axitinib Bones, live, LN
PD: pancreaticoduodenoctomy.
Table 2. Characteristics of included case.
Table 2. Characteristics of included case.
Feature nAverage/Percentage
Male/Female ratio 554/1
Average age 5564 years
Metachronous vs. synchronous 55
Metachronous49 89%
DFI (median) 457 years
Synchronous6 11%
RCC side 48
Bilateral1 2%
Left19 40%
Right28 58%
Symptoms545598%
Lethargy–general symptoms22 40%
Occlusion5 9%
Abdominal pain10 18%
Bleeding (upper and lower)36 65%
Upper GI bleeding12 22%
Lower bleeding (Melena, hematoschezia)26 47%
Anemia32 58%
Fever4 7%
Jaundice-cholestasis5 9%
Other metastasis site205536%
Localization of the tumor 44
Second duodenum35 80%
Periampullary12 27%
Angulus2 5%
First Duodenum6 14%
Third duodenum1 2%
Treatment 48
Surgery alone23 48%
Medical therapy alone11 23%
Surgery + medical therapy5 10%
Paliative RT3 6%
No treatment6 13%
Overall Survival-Median 48 months
RT: Radiotherapy; RCC: Renal Cell Carcinoma; DFI: Disease Free Interval; GI: Gastro-Intestinal.
Table 3. Features of patients treated with surgery vs. patients treated without surgery.
Table 3. Features of patients treated with surgery vs. patients treated without surgery.
Surgery (n = 28)No Surgery (n = 20)np
Age, median60.5 [55.2; 66.0]70.0 [59.5; 76.0]480.028
Sex (Male proportion)22 (79%)16 (80%)381
DFI, median8.00 [6.00; 11.0]4.00 [1.50; 9.25]410.067
Bleeding/anemia22 (79%)15 (75%)371
LocalisationD216 (80%)14 (74%)300.35
D14 (20%)2 (11%)6
ANGULUS0 (0%)2 (11%)2
D30 (0%)1 (5.3%)1
Metachronous metastasis25 (89%)17 (85%)420.68
Nephrectomy sideRight16 (57%)10 (50%)260.88
Left9 (32%)9 (45%)18
Bilateral1 (3.6%)0 (0%)1
Other metastasis localisation, n18 (64%)15 (75%)330.43
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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

AMA Style

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 Style

Taha, 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 Style

Taha, 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

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