Management and outcomes of solid pseudopapillary neoplasm of the pancreas: a systematic review

Solid pseudopapillary neoplasm of the pancreas (SPN-P) is a rare entity, accounting for about 0.9-2.7% of all exocrine and 5% of cystic pancreatic neoplasms. There is limited evidence on the clinical, surgical, and oncological characteristics of SPN-P, as well as surgical short- and long-term outcomes. A systematic review was conducted searching four databases (MEDLINE/PubMed, Web of Science, Scopus and Cochrane Library) from January 2004 to August 2024, adhering to the reporting standards for systematic reviews. Eligible studies of provided information on key clinical features of SPN-P, surgical management, and surgical and oncological outcomes were reviewed. A total of 1315 studies were identified, of which 54 met the inclusion criteria. Data from 1.888 SPN-P patients, comprising 1.617 women (85.6%) and 271 men (14.4%), with a mean age of 30, 7 years (range: 7-87 years) were collected. Of these patients, 1.882 underwent surgical intervention, and 1.869 received pancreatic resection. The most common postoperative complication was postoperative pancreatic fistula, which was more prevalent in cases of parenchyma-preserving surgery (23%). Other complications included wound infections, intra-abdominal collections, delayed gastric emptying, and pancreatic insufficiency. Surgical intervention remains the gold standard for the treatment of SPN-P, offering favourable oncological outcomes and an excellent prognosis. Nonetheless, further research is required to address unresolved aspects of SPN-P surgical management and optimize treatment protocols.