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Duodenum-sparing technique of head resection in solid pseudopapillary tumor of the pancreas in children
1Department of Pediatric Surgery, Institute of Postgraduate Medicine, Charles University, 2nd Medical School, V Uvalu 84, Prague, Czech Republic. jiri.snajdauf@fnmotol.cz
Insights
Solid pseudopapillary tumor of the pancreas (SPTP) in children is rare and has low malignancy. A duodenum-sparing technique for pancreatic head tumors offers favorable outcomes and avoids extensive surgery.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Pancreatic Tumors
Background:
- Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasm predominantly affecting young females.
- Surgical management of SPTP, especially in the pancreatic head, traditionally involved extensive resections.
Purpose of the Study:
- To evaluate complications and long-term outcomes of pediatric SPTP surgical treatment.
- To assess the efficacy of a novel duodenum-sparing technique for pancreatic head SPTP.
Main Methods:
- Retrospective analysis of 13 pediatric patients with SPTP treated between 1993-2008.
- Focus on operative techniques, including a duodenum-sparing approach for head tumors and distal resections for body/tail tumors.
Main Results:
- 12 girls and 1 boy, average age 14 years.
- Duodenum-sparing resection performed in 6/7 head tumors; distal resection in 4/4 tail tumors.
- All patients survived with no tumor recurrence at 6 months to 16 years; minor complications like biliary fistula occurred but resolved.
Conclusions:
- SPTP has low malignant potential, negating the need for perioperative chemotherapy.
- Duodenum-sparing resection is a less invasive and more appropriate technique for pediatric SPTP in the pancreatic head.
- Favorable short- and long-term results support the use of this conservative surgical approach in children.
Aim Of Study:
Aim of the study was to assess the complications and long-term results in children operated on for solid pseudopapillary tumor of the pancreas (SPTP) between 1993-2008 at the authors' institution with a focus on a novel duodenum-sparing technique to treat tumors of the head of the pancreas.
Methods:
Retrospective analysis was performed of patient data including demographics, diagnostic measures, the operative technique focusing on tumor of the head of the pancreas, complications and long-term results.
Results:
There were 13 patients (12 girls and one boy) with an average age of 14 years (9-17.5 years) at operation. In 7 patients the tumor was localized in the head of the pancreas, in 4 patients in the tail, and in 2 patients both the body and tail were involved. Patients with body and tail involvement underwent distal pancreatic resection. In 6 patients with head involvement a duodenum-sparing resection of the head and end-to-end anastomosis of the excluded jejunal loop either to the corpus or tail of the pancreas were performed. One girl underwent a modified Whipple operation. She developed a biliary fistula which closed after three weeks with endoscopic stenting. One patient with head resection developed a biliary fistula which closed after two weeks of stenting. One patient who underwent resection of the pancreatic head complained of recurrent abdominal pain one year postoperatively. All patients are alive without tumor recurrence at 6 months to 16 years after operation.
Conclusion:
SPTP is a rare pancreatic tumor with a low degree of malignancy. No perioperative chemotherapy is necessary. Therefore duodenal resection in cases of SPTP in the head of the gland seems too invasive and mutilating. The authors consider the duodenum-sparing technique to be more appropriate for the developing organism of a child. Favorable short and long-term results support this opinion.
