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Nonparasitic splenic cysts in children: a multicentric study
P Czauderna1, P Vajda, K Schaarschmidt
1Department of Surgery and Urology for Children and Adolescents, Medical University of Gdañsk, Poland.
Insights
Surgical management of nonparasitic splenic cysts in children has shifted towards spleen-preserving techniques. While effective, cyst fenestration or deroofing shows a high recurrence rate, necessitating careful consideration of surgical approaches.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Pediatric Urology
Background:
- Nonparasitic splenic cysts (NPSCs) are rare in pediatric patients.
- Management trends for NPSCs have evolved over time.
Purpose of the Study:
- To review the authors' experience with NPSCs in children.
- To analyze changing trends in NPSC management over 25 years.
Main Methods:
- Retrospective review of 50 pediatric patients surgically treated for NPSCs.
- Data collected from 6 European pediatric surgical centers between 1981 and 2005.
Main Results:
- 50 children (mean age 11.9 years) underwent surgery for NPSCs.
- Spleen-preserving procedures increased, including partial splenectomies (n=26) and cystectomies (n=9).
- Epidermoid cysts were most common (n=28); 8/50 patients had residual cysts post-laparoscopy, with 4 requiring reoperation.
Conclusions:
- Surgical treatment has shifted from total splenectomy to spleen-conserving methods.
- Laparoscopic approaches are feasible for spleen-preserving NPSC treatment.
- Fenestration/deroofing techniques are associated with a high recurrence rate (7/9).
Purpose:
Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was to present the authors' experience as well as the changing trends in the management of NPSCs over the last 25 years.
Material And Methods:
From 1981 to 2005, 50 children or adolescents were surgically treated for NPSCs in 6 paediatric surgical centres in four European countries. The medical records of these 50 patients with NPSCs were reviewed retrospectively.
Results:
Twenty-six male and 24 female patients were operated on. Age at surgery ranged from 1 to 17 years (mean 11.9). Seventeen patients were symptomatic. Six total (4 open and 2 laparoscopic) and 26 partial (22 open and 4 laparoscopic) splenectomies were performed. Laparoscopic fenestration or deroofing and open cystectomy was carried out in 9 patients, respectively. Histological findings revealed the lesion to be an epidermoid cyst (n = 28), a pseudocyst (n = 15) or a mesothelial cyst (n = 2). In 5 patients haemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required re-do laparoscopy or open surgery.
Conclusions:
Over the last two decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures, such as total cystectomy with or without partial splenectomy or partial cystectomy. These therapeutic modalities can be performed laparoscopically, if technically possible. Fenestration or deroofing of the cyst resulted in a high recurrence rate (7/9).