Curative‐Intent Pancreatectomy for Pancreatic Metastasis From Renal Cell Carcinoma 30 Years After Nephrectomy Following Lenvatinib Plus Pembrolizumab Therapy: A Case Report

Introduction Renal cell carcinoma (RCC) is the most common primary site of pancreatic metastases, and complete resection confers a favorable prognosis. Lenvatinib plus pembrolizumab (LEN + PEM) is standard first‐line therapy for advanced RCC; however, induction therapy before resection of pancreatic metastasis has not been reported. Case Presentation A 77‐year‐old man presented with weight loss, anemia, and elevated inflammatory markers 30 years after radical nephrectomy for RCC. Contrast‐enhanced computed tomography revealed a 42‐mm pancreatic head mass compressing the inferior vena cava, considered resectable, but high risk. Endoscopic ultrasound‐guided fine‐needle aspiration confirmed metastatic clear cell RCC. After LEN + PEM induction, the tumor decreased to 29 mm, vena cava compression resolved, and subtotal stomach‐preserving pancreaticoduodenectomy achieved R0 resection. The patient remained recurrence‐free at 5 months. Conclusion LEN + PEM induction enabled R0 resection of pancreatic RCC metastasis, a site for which this strategy has not previously been reported.