Accurate resection of pediatric pancreatic tumors: a report of 15 cases

Abstract

Objective To explore the influencing factors for pediatric surgical resection of pancreatic tumor and examine the feasibility of accurate surgical resection. Methods Retrospective analyses of clinical data were conducted for 15 cases of pediatric pancreatic tumors from October 2002 to July 2013. There were 10 girls and 5 boys with a mean age of 100 (4-168) months. The lesion sites were pancreatic head (n=9), pancreatic body & tail (n=6), hepatic metastasis (n=1) and hepatic & mesenteric (n=1). Results The surgical procedures included pylorus-preserving pancreaticoduodenectomy (n=7), resection of pancreatic tumors derived from protruding hook (n=2) and resection of pancreatic body/tail plus splenectomy (n=6). Pathological types were pancreatic cystic false papilloma (n=9), pancreatic blastoma (n=3), serous (n=1), islet cell carcinoma (n=1) and desmoplastic small round cell tumor (n=1). After successful surgery, all children recovered well during a follow-up period of 6 months to 12 years. Except for 1 child dying from desmoplastic small round cell tumor, the remainder survived. Conclusions Surgical removal of tumor is essential for treating pediatric pancreatic tumors. Most pancreatic tumor children may obtain long-term survival only by surgical removal. The operative principles are maintaining the continuity of gastrointestinal tract and performing accurate surgery as much as possible to retain normal pancreatic tissue. The major influencing factors for surgical approaches of pediatric pancreatic tumors are tumor location and whether or not there are violations of surrounding tissue, bile duct, common pancreatic duct and splenic blood vessels. The examinations of CT and MRCP are standard for offering preoperative assessments of bile duct and pancreatic duct and determining accurate operation modes. Key words: Pancreatic neoplasms; Digestive system surgical procedures; Retrospective studies