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Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN).

Oliver Standring1, Susana Benitez Sanchez1, Shamsher Pasha2

  • 1Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA.

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Observation may be suitable for small, localized pancreatic solid pseudopapillary neoplasms (SPN). This study found no occult nodal metastasis in early-stage SPN, suggesting observation can mitigate resection risks.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Solid pseudopapillary neoplasms (SPN) are rare pancreatic tumors predominantly affecting young women.
  • Surgical resection is the standard treatment but carries significant risks.
  • This study investigates the safety of observing small, localized SPN.

Purpose of the Study:

  • To evaluate the feasibility of non-operative management for select SPN cases.
  • To determine the risk of occult nodal metastasis in early-stage SPN.
  • To identify criteria for safely observing SPN and avoiding unnecessary surgery.

Main Methods:

  • Retrospective review of the Pancreas National Cancer Database (2004-2018).
  • Identification of SPN using histology code 8452.
  • Analysis of clinical staging, surgical resection rates, and occult nodal metastasis.

Main Results:

  • 994 SPNs were identified; 84.9% of patients were female, with a mean age of 36.8 years.
  • Resection was performed in 96.6% of patients.
  • No occult nodal metastasis was found in cT1 (0%) or cT2 (0.5%) SPN, but risk increased significantly for cT3 (8.9%) and cT4 (50%) disease.

Conclusions:

  • Clinical assessment accurately excludes nodal involvement in tumors ≤ 4 cm (99.5% specificity) and ≤ 2 cm (100% specificity).
  • Close observation may be a safe option for patients with cT1N0 SPN.
  • Observation can help reduce morbidity associated with major pancreatic resections.