Journal of Surgery

Treatment of Bleeding Secondary to Gastric Metastases from Renal Cell Carcinoma Primary

Abstract

Katherine M Guest, George J Joy, Robin Som and Rajab Kerwat

Gastric metastases from primary renal cell carcinoma (RCC) are uncommon, but not as rare as once thought. These metastases frequently present with upper gastrointestinal (UGI) bleeding. We report two such cases, and utilising lessons learnt from them, and from a literature review, propose a model of treatment for UGI bleeding secondary to metastases from RCC primaries. Both patients presented with clinically significant UGI bleeding secondary to RCC metastasis to the stomach. A literature search was conducted and a qualitative review of the published case reports and studies were undertaken. The two cases were discussed in a multi-disciplinary setting to plan management. One patient underwent gastric wedge resection; the second patient received palliative radiotherapy. Cessation of bleeding was achieved in both cases. A total of 48 cases were identified from the literature search. The reports indicate that surgery for gastric metastases has favourable outcomes in patients who do not have concurrent metastases. Palliative radiotherapy in this setting has not previously been described. A model of how these patients could be managed was subsequently constructed; the key question to answer is how disseminated the disease is. Treatment modalities are still debated and should be discussed on a case-by-case basis. However, the literature suggests that surgical intervention has good therapeutic and prognostic benefit in patients with isolated metastatic disease to the stomach. For those with widespread metastases, there are several management options available. We advise that radiotherapy should also be considered as an option in the management of patients with bleeding lesions and concurrent metastatic disease.