Pancreatic head sparing surgery for solid pseudopapillary tumor in patients with agenesis of the dorsal pancreas

Abstract

Background: This study aimed to clarify the feasibility and justification of pancreatic head sparing (PHS) enucleation for patients with agenesis of the dorsal pancreas (ADP) associated with a solid pseudopapillary tumor (SPT). Methods: Data of the SPT patients with and without ADP, including clinical presentations, surgical options, and surgical and survival outcomes, were recruited for comparison. Results: A total of 31 patients with SPTs were included, three of whom displayed ADP and underwent PHS enucleation. Surgical complications were comparable between the groups. Overall, the 5- and 10-year disease-free survival rates were 100% and 90%, respectively. The 20- and 25-year overall survival rates were 100% and 66.7%, respectively. Only one patient (3.2%) developed tumor recurrence 7.3 years after pancreatectomy for an SPT with lymph node involvement, and the patient survived 24.5 years after the initial operation. No tumor recurrence occurred in any patient with ADP after PHS enucleation. Conclusion: PHS enucleation seems to be feasible and justifiable for SPT patients with ADP in terms of surgical and survival outcomes, and this approach could be recommended to avoid pancreatic insufficiency.

Organ- or function-preservation surgery is recommended, but who is a candidate?

“…6 All contribute to the re-consideration of the old proverb “to do more and to lose more.” 7 The recent publication in the October issue of the Journal of the Chinese Medical Association entitled “Pancreatic head sparing surgery for solid pseudopapillary tumor in patients with agenesis of the dorsal pancreas,” showed the feasibility and possible safety of using sparing surgery of the pancreatic head (pancreatic head sparing surgery [PHSS]) in the management of patients with agenesis of the dorsal pancreas (ADP) accompanied by a solid pseudopapillary tumor (SPT). 8…”

“…8 The authors retrospectively enrolled three patients with ADP accompanied with SPT who were treated with PHSS, and the results showed all patients who were alive ranged from 22 months to 75 months, even though one patient could not be totally resected for her SPT. 8 Additionally, the authors evaluated 28 patients with SPT without ADP, and the outcomes of these patients were also excellent with a 100% of 20-year overall survival (OS) rate. 8 Then, based on the concept of preservation of pancreas function and/or avoidance of pancreatic insufficiency, the authors suggested that PHSS for SPT is a feasible and safe method, and they particularly emphasized its feasibility for SPT patients concomitant with ADP.…”

“…8 Additionally, the authors evaluated 28 patients with SPT without ADP, and the outcomes of these patients were also excellent with a 100% of 20-year overall survival (OS) rate. 8 Then, based on the concept of preservation of pancreas function and/or avoidance of pancreatic insufficiency, the authors suggested that PHSS for SPT is a feasible and safe method, and they particularly emphasized its feasibility for SPT patients concomitant with ADP. 8 The current article is interesting and worthy of further discussion.…”

“…8 Then, based on the concept of preservation of pancreas function and/or avoidance of pancreatic insufficiency, the authors suggested that PHSS for SPT is a feasible and safe method, and they particularly emphasized its feasibility for SPT patients concomitant with ADP. 8 The current article is interesting and worthy of further discussion.…”

Neoadjuvant therapy

“…1 Life-saving is the most critical issue for cancer treatment; however, the patients not only wish to be cured from the diseases but also want to have a good to excellent posttreatment recovery as well as had better have their organ-preservation or complete return of the function to maintain good quality of life (QoL) in their remaining life, and these wishes now have become an optimal therapeutic goal for both physicians and patients. [2][3][4] An accurate and precise pretherapy evaluation and an appropriate and personalized therapeutic plan for these cancer or critically ill patients through the far-advanced development of new technology or therapeutic strategy, such as a minimally traumatic organ-preservation approach and a method for maintenance of physiological and morphological function of targeted lesions can minimize the risk of overtreatment and subsequently avoid the development of severe posttherapy sequelae without compromising the therapeutic efficacy. [5][6][7] To reach this goal, it is still challengeable.…”