Laparoscopic Spleen-Preserving Distal Pancreatectomy for Solid Pseudopapillary Neoplasm in Adolescents

Solid pseudopapillary neoplasm (SPN) is the most commonly encountered pancreatic tumor in adolescents. Owing to its malignant potential, the current recommendation for management is complete surgical resection; however, there is no broad consensus on the operation of choice to accomplish this. Herein, we describe three consecutive laparoscopic spleen-preserving distal pancreatectomies for SPN in adolescents. Our cohort included all patients <18 years of age treated at our institution from 2015 to 2018 who underwent surgical resection of an SPN. Three patients (age 13-16) were identified. Two of the patients were male. All patients underwent laparoscopic distal pancreatectomy with preservation of the main splenic artery and vein. No patients suffered from postoperative pancreatic fistula. Median length of stay was 5 days. Final histology revealed SPN in all 3 cases, with tumor size ranging from 2 to 10 cm in greatest dimension. All margins were negative for tumor. All 3 patients have been followed (mean: 6 months) with surveillance ultrasound demonstrating a normal remnant pancreas and normal splenic perfusion. Laparoscopic spleen-preserving distal pancreatectomy is a safe and effective treatment for SPNs of the body and tail of the pancreas in adolescents. This approach achieves the margin negative resection that is appropriate for the disease without subjecting children to the risk of postsplenectomy sepsis or the need for antibiotic prophylaxis, and may be associated with a reduction in perioperative morbidity. Therefore, laparoscopic distal pancreatectomy with splenic preservation is our preferred operation in adolescents presenting with SPN.