Laparoscopic Warshaw Procedure for Solid Pseudopapillary Neoplasms in Children

Area of Science:

• Pediatric Surgery
• Surgical Oncology
• Abdominal Imaging

Background:

• Solid pseudopapillary neoplasms (SPNs) in the pancreas body/tail can necessitate distal pancreatectomy.
• Laparoscopic approaches offer minimally invasive options, potentially including spleen preservation.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic distal pancreatectomy using the Warshaw technique for spleen preservation in pediatric patients with SPN.
• To assess oncologic outcomes and resource utilization associated with this surgical approach.

Main Methods:

• Retrospective review of pediatric SPN patients (≤19 years) undergoing laparoscopic Warshaw procedure (January 2006-December 2023).
• Preoperative and postoperative CT scans analyzed for tumor, pancreas, and spleen volumes using volumetric analysis.
• Descriptive statistics to evaluate spleen salvage, oncologic control, and perioperative outcomes.

Main Results:

• All five pediatric patients successfully underwent spleen salvage via laparoscopic Warshaw procedure.
• Postoperative splenic volumes averaged 93.9% of preoperative size, increasing to 110.6% over time, with collateral flow enhancement.
• All SPNs were resected with negative margins, and no recurrence was observed during a median follow-up of 407 days.
• Procedure demonstrated low morbidity with median estimated blood loss of 100 mL, procedure length of 4.9 hours, and hospital stay of 3 days.

Conclusions:

• Laparoscopic Warshaw technique is highly effective for spleen preservation in pediatric SPN cases.
• This approach maintains oncologic fidelity and efficient inpatient resource use.
• The technique supports long-term splenic volume restoration and function through collateral circulation.