Radical resection of the pancreas should not always be necessary in the surgical management of pancreatic solid pseudopapillary tumor in children

Abstract

Background/Aims: Pancreatic solid pseudopapillary tumor (SPT) is a rare neoplasm in children. In this study, we aimed to present our surgical strategy based on minimal resection by enucleation or limited resection in localized pancreatic SPT. Materials and Methods: We retrospectively analyzed the medical records of children who underwent surgical resection between October 2011 and September 2016. Results: Five female patients with a median age of 15 years (range, 14-17 years) were operated. Tumors were located in the pancreatic head (n=4) or tail (n=1). The median greatest tumor diameter was 9 cm (range, 5-13 cm). All the patients were investigated with MRI before the resection to demonstrate the relationship between the tumor and the main pancreatic duct. Patients underwent enucleation (n=4) for head localization or local distal resection without splenectomy (n=1) at the pancreatic tail. At postoperative follow-up, major pancreatic leakage was observed in two patients and endoscopically treated. Surgical margins were negative in all patients. The median follow-up period was 44 months (range, 2-59 months) and no local recurrence or distant metastasis was observed in the postoperative period. Conclusion: An optimal surgical strategy is still controversial in pancreatic SPT in children. Radical resections such as pancreaticoduodenoctomy or distal pancreatectomy with splenectomy result in loss of pancreatic tissue for endocrine and exocrine functions. Minimal resections such as enucleation or limited pancreatic resection with negative surgical margins should be performed in selected patients with no invasion to the main pancreatic duct or adjacent organs.

Long-term outcome of pancreatic function following oncological surgery in children: Institutional experience and review of the literature

“…In Tables 3 and 4 we summarize the main characteristics of the studies that focused on long-term outcome of pancreatic functions following oncological surgery in children[ 26 - 37 ]. The data showed that the prevalence of exocrine insufficiency in pediatric patients ranged from 0%[ 29 ] to 83.3%[ 33 ]. Vasudevan et al [ 27 ] found exocrine failure rate similar to our finding (23%), while Cheng et al [ 26 ] found a much lower rate (8.6%).…”

“…We found endocrine failure in 12.5% and Vasudevan et al [ 27 ] found endocrine failure in 3%. No patients with endocrine insufficiency were found in seven surveys[ 28 , 29 , 31 , 33 , 35 - 37 ]. Cheng et al [ 26 ] reported that only one patient developed endocrine insufficiency in 104 and Park et al [ 34 ] found one in 8 patients.…”

Solid pseudopapillary neoplasm of the pancreas in children: Hacettepe experience

“…In children, surgical resections should be as conservative as possible. Instead of radical resections such as pancreaticoduodenoctomy or distal pancreatectomy with splenectomy, enucleation or limited pancreatic resection with negative surgical margins are advocated . In children, it is especially important to recognize this entity because tumour resection can be performed without large safety margins and to avoid long‐term complications, the preservation of pancreatic tissue and spleen should be attempted .…”

Pancreatic Cystic Neoplasms: Diagnosis, Management and Indications for Surgical Procedures. Part II

“…In case of diagnostic uncertainty, EUSguided fine needle aspiration is recommended, which plays an important role in providing accurate and reliable preoperative cytological diagnosis (61,62,63). Papavramidis and Papavramidis (49) include CT-guided FNA in the SPN diagnostic algorithm.…”