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Robotic Duodenum-preserving Total Pancreatic Head Resection for Intraductal Papillary Mucinous Neoplasms
Published on: April 17, 2026
Extremely large solid pseudopapillary neoplasm of the pancreas
Richi Nakatake1,2, Hiroaki Kitade3,4, Hidesuke Yanagida3
1Department of Pancreatobiliary Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan. nakatake.ric@kmu.ac.jp.
Clinical Journal of Gastroenterology
|June 15, 2026
Summary
Extremely large solid pseudopapillary neoplasms (SPNs) of the pancreas, even those exceeding 20 cm, can be safely resected. Tumor size does not solely predict aggressive behavior in these rare pancreatic tumors.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Solid pseudopapillary neoplasms (SPNs) are uncommon pancreatic tumors with low malignant potential.
- While SPNs typically grow slowly, exceptionally large tumors (>20 cm) are exceedingly rare.
Purpose of the Study:
- To report a case of an extremely large SPN and its surgical management.
- To highlight that tumor size alone is not indicative of aggressive behavior in SPNs.
Main Methods:
- A 45-year-old woman with an incidentally discovered 20 cm cystic abdominal mass underwent contrast-enhanced CT and MRI.
- Complete surgical resection of the 22x22 cm SPN was performed.
- Histopathological and immunohistochemical analyses confirmed the diagnosis.
Main Results:
- The SPN measured 22x22 cm, with typical histological and immunohistochemical features.
- Surgical resection was completed with minimal blood loss and a 4-hour operative time.
- The patient experienced postoperative portal vein thrombosis, successfully managed with anticoagulation, and remained recurrence-free at 5 years.
Conclusions:
- Extremely large SPNs can be safely and effectively resected.
- Excellent long-term outcomes are achievable even for giant SPNs.
- Tumor size should not be the sole factor in assessing the biological behavior of SPNs.
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