Surgery for metastasis to the pancreas: systematic review of observational cohort studies

BACKGROUND: Pancreatectomy of metastases to the pancreas from other cancers is uncommon. Despite the rarity, several tumour entities have been described to metastasise to the pancreas and having undergone resection. The aim of this review was to collect studies reporting all-sites of origin and compare survival after pancreatectomy. METHODS: A systematic review of PubMed/Medline for observational studies from 2009 to 2025 reporting all-sites of origin with metastasis to the pancreas. RESULTS: Fifteen cohort studies with 613 pancreatectomies for metastases were reported, with 346 (56.4 %) from renal cell carcinoma (RCC). Among non-RCC indications, colorectal cancer (10.1 %) gynaecological cancers (7.3 %), sarcomas (6.3 %) and melanoma (4.6 %) were most frequent. Distal pancreatectomy was the most frequent procedure (63.7 %) followed by pancreatoduodenectomy (30 %) and total pancreatectomy (11.4 %). Other procedures including enucleations were done in in 8.3 %. Overall survival was best for pancreatectomy from RCC-metastasis, approaching 10 years median survival in the most recent studies, with a significant difference compared to all non-RCC indications. CONCLUSION: Pancreatectomy for metastasis is reported with an increase in non-RCC origins. Distal pancreatectomy is performed in two-thirds. Long-term survival up to 10 years was reported after surgery for RCC. Considerably lower survival was reported in other primary cancer sites (PROSPERO#CRD42025633602).