Minimally Invasive Versus Open Resection for Solid Pseudopapillary Tumors of the Pancreas: A Propensity Score-Matched Analysis.

Clinical features and treatment of solid pseudopapillary neoplasm of the pancreas

Objective To investigate the clinical features,diagnosis and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Method The clinical data of SPTP cases that underwent surgical resection with a definitive histological diagnosis in Zhong Shan Hospital from 1999 to 2007 were retrospectively analyzed.Result There were 42 SPTP cases undergoing surgery in this period,including 37 females and 5 males:mean age was 37.6 years.Tumors located in the pancreatic head in 18 cases and in the body or tail in 24 cases.The most common symptom was abdominal discomfort(n=20),palpable mass (n=8).Preoperative diagnostic accuracy of MRI and CT were 93%and 31.8%,respectively.Ten cases underwent pancreaticoduodenectomy,20 cases received distal pancreatectomy,3 cases did spleen-preserving distal pancreatectomy.Tumors were simply enucleated in 8 cases.Average diameter of the tumors was 6.1 cm,34 lesions were solid,6 were solid-cystic,2 were cystic.The overall perioperative morbidity was 38.1%,10 cases developed postoperative pancreatic fistula.The mean follow-up time was 38.6 months.Except three cases that were lost to follow-up,all the other cases were alive.Four cases(2 cases had had tumor enucleation,2 had had distal pancreatectomy)developed hepatic metastases on 70、110、41、3 months after first surgery,respectively.A transarterial chemoembolization was employed in three cases,while right hemihepatectomy was performed in one case. Conclusion SPTP is an indolent tumor with low-grade biological aggressiveness.Patients had a favorable outcome after surgical treatment,but enucleation should be avoided.Patients with liver metastasis may benefit from chemoembolization and liver resection. Key words: Pancreatic neoplasms; Diagnosis; Treatment; Solid pseudopapillary tumors of the pancreas

Objective To discuss the diagnosis and treatment of the solid pseudopapillary tumor of the pancreas(SPTP). Methods Six consecutive cases operated in our hospital from Aug. 2008 to Apr. 2010were reviewed. Results Those cases aged ranging from 17 to 31 years, with an average age of 21.8 years.The maximal dimension of tumor ranged from 6.6 to 13.0 cm, averaging 8.2 cm. Those tumors originated from pancreatic head (2), and body or tail (4). Abdominal B-ultrasound or CT scan examination disclosed that pancreas had solid-cystic mass in 4 cases, and the other two had solidmass. All tumors were resected completely and defined pathologically. We performed 5 open operations, including pancreaticoduodenectomy (2 cases), spleen-preserving distal pancreatectomy (2 cases) and distal pancreatectomy plus splenectomy (1 case). One case underwent laparoscopic distal pancreatectomy plus splenectomy. Conclusions The young females are more likely suffered from the SPTP than others, which usually has a clear boundary and large volume. The abdominal B-ultrasound and CT scan are important diagnostic methods. The surgical modality of pancreatectomy is dependent on the tumor's location and extent, furthermore the resectability of SPTP is high. It is possible to perform a spleen-preserving distal pancreatectomy for tumors located in pancreatic body or tail. Key words: Solid pseudopapillary tumor; Pancreas; Diagnosis; Treatment

To present comprehensive information on the clinicopathological, molecular, survival characteristics, and quality of life (QOL) after surgery for solid pseudopapillary neoplasm (SPN) of the pancreas in a large cohort after long-term follow-up. SPN is a rare tumor with an uncertain malignant potential, and solid information on long-term prognosis and QOL remains limited. All hospitalized patients with SPNs who underwent surgery between 2001 and 2021 at the Peking Union Medical College Hospital were retrospectively reviewed. The clinicopathological characteristics of the patients were retrieved. A cross-sectional telephone questionnaire was administered to inquire about the QOL. Molecular analyses were performed using whole-exome sequencing. Exactly 454 patients with SPN were enrolled, of whom 18.5% were males and 81.5% were females. The mean patient age was 31 ± 12 years. In total, 61.3% of the patients had no symptoms. The size of the tumors was 5.38 ± 3.70 cm; 83.4% were solid cystic tumors, and 40.1% had calcifications. The proportions of local resection, distal pancreatectomy with or without splenectomy, and pancreaticoduodenectomy with or without pylorus preservation were 29.7%, 28.9% or 22.9%, and 11% or 6.8%, respectively. Over the years, there has been a significant shift from open to minimally invasive surgery. Among all surgical procedures, pylorus-preserving pancreaticoduodenectomy (PPPD) had the highest incidence of grade 2 to 4 complications (up to 32.3%), compared with 6.7% in distal pancreatectomy ( P < 0.001). Regarding histopathology, tissue invasion, perineural invasion, cancerous microvascular emboli, lymph node metastasis, and distant metastasis were present in 16.5%, 2.2%, 0.7%, 2.0%, and 3.1% of patients, respectively. Sixty patients were lost to follow-up. Sixteen of the 390 patients who underwent resection (4.1%) experienced local recurrence or distant metastasis after surgery. In total, 361 patients responded to the telephone survey. Nearly 80% of patients claimed their QOL was not significantly affected after surgery; however, the remaining 20% complained of lower QOL during 3 to 6 years of follow-up after surgery. No clinicopathological factor could reliably predict clinical recurrence or metastasis after resection. A total of 28 driver genes were detected with mutations in at least 2 tumor samples and the top 3 frequently mutated genes were CTNNB1 , ATRNL1 , and MUC16 . This study presented the largest cohort of patients with SPN after surgery from a single center and reported the QOL of these patients. SPN is associated with extremely favorable long-term survival, even in patients with metastasis, and most patients have a good QOL after surgery.

Solid-pseudopapillary neoplasm (SPPN) of the pancreas is a distinctive tumor of low malignant potential with a predilection for female patients in the second and third decades of life. We studied nine cases of SPPN of the pancreas and reviewed the literature concerning these uncommon tumors. A total of 7 cases of SPPN located in the tail of the pancreas and two located in the head of the pancreas were presented. Distal pancreatectomy in three patients and distal pancreatectomy with splenectomy in two patients Whipple's operation in four patients were performed. Histological diagnosis was made by performing hematoxylin-eosin and periodic acid-Schiff staining, immunohistochemical staining. Follow-up of the patients was between 2 months and 12 years. Computed tomography and magnetic resonance imaging were found as equivocal for diagnosis. Mass containing cystic and solid areas were not characteristic but raised suspicion of SPPN. Pathologic examination showed SPPN in all patients. No metastasis or recurrence was detected during follow-up. Solid-pseudopapillary neoplasm is a relatively rare tumor, and patients tend to survive for a long period. Preoperative imaging is not characteristic. Pathologic examination is the mainstay in the diagnosis. Complete surgical removal is the best choice of treatment.

Objective To analyze the experience in diagnosis and surgical treatment for solid pseudopapillary neoplasm(SPN) of pancreas in children. Methods A retrospective study was performed in 12 pediatric patients with SPN who had been admitted to Affiliated Cancer Hospital of Zhengzhou University during January 2004 to December 2016, and their general data, demographic data, types of operations, postoperative complications and follow-up were analyzed. Results Among the 12 patients, 3 cases were male and 8 cases were female, with average age 14.3 years old(11-17 years old). The main clinical manifestations included abdominal pain(4/12 cases, 33.3%), abdominal mass(2/12 cases, 16.7%) and trauma(2/12 cases, 16.7%). In those 12 patients, 33.3%(4/12 cases) SPN was located at the head of the pancreas, and 66.7%(8/12 cases) at the body and tail of it.The tumors were usually large, the largest diameter ranged from 4.0 to 15.3 cm(average largest diameter, 8.2 cm). The color ultrasonography indicated heterogeneous echogenic mass and clear boundary.CT scanning indicated that the tumor was a low-density cystic mass with a clear boundary, with enhanced tumor real component and irregular reinforcement.No calcification was found in the patients.Dynamic enhanced magnetic resonance imaging scan revealed gradual strengthening solid components in tumor.All the patients received surgical resection, with distal pancreatectomy in 4 patients, pancreaticoduodenectomy in 4 patients, spleen-preserving distal pancreatectomy in 2 patients, Enucleation in 1 patient, and distal pancreatectomy and self-splenic slices transplantation in 1 patient.Lymphadenectomy was performed in 4 patients, and all the 21 removed lymph nodes were all negative.Pathological diagnosis confirmed the SPN in all the patients, among them 3 cases were malignant SPN, and one of them with tumor rupture and hemorrhage.The mean follow-up duration was 57.7 months(19-156 months) and no recurrence was found. Conclusion SPN is a rare neoplasm in children who go to see doctors because of clinical symptoms.Surgical resection, especially organs-preserving resection, may improve the long-term results. Key words: Solid pseudopapillary neoplasm; Child; Surgical resection

PurposeLaparoscopic distal pancreatectomy (LDP) has been widely performed for solid pseudopapillary neoplasm (SPN) involving the body or tail of the pancreas. However, it has not been established whether spleen preservation in LDP is oncologically safe for the treatment of SPN with malignant potential. In this study, we compared the short- and long-term outcomes between patients with SPN who underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) vs laparoscopic distal pancreatectomy with splenectomy (LDPS).MethodsWe retrospectively reviewed the medical records of 46 patients with SPN who underwent LDP between January 2005 and November 2016. Patients were divided into 2 groups according to spleen preservation: the LSPDP group (n=32) and the LDPS group (n=14). Clinicopathologic characteristics and perioperative outcomes were compared between groups.ResultsThere were no significant differences in pathologic variables, including tumor size, tumor location, node status, angiolymphatic invasion, or perineural invasion between groups. Median operating time was significantly longer in the LSPDP group vs the LDPS group (243 vs 172 minutes; p=0.006). Estimated intraoperative blood loss was also significantly greater in the LSPDP group (310 vs 167 ml; p=0.063). There were no significant differences in incidence of postoperative complications (≥ Clavien-Dindo class IIIa) or pancreatic fistula between groups. After a median follow-up of 35 months (range, 3~153 months), there was no recurrence or disease-specific mortality in either group.ConclusionThe results show that LSPDP is an oncologically safe procedure for SPN involving the body or tail of the pancreas.

Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed. During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16-66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23months, no tumour recurrence or death was recorded. In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.

While solid pseudopapillary tumor (SPT) of the pancreas are oncologically low-risk tumors, their resection with pancreaticoduodenectomy (PD) or partial pancreatectomy (PP) carries a significant risk for morbidity. To balance the favorable prognosis with the surgical morbidity of pancreas resection, this study explores the oncologic safety of enucleation(EN). The National Cancer Database (NCDB) was queried for resected SPT from January 2004 through December 2020. Perioperative outcomes and survival were analyzed with Kruskal-Wallis tests, and Kaplan-Meier analysis (with log-rank test). Survival analysis was performed to compare patients with and without lymph node (LN) metastases and binary logistic regression for predictors of LN metastasis. A total of 922 patients met inclusion criteria; 18 patients (2%) underwent EN, 550 (59.6%) underwent PP, and 354 (38.4%) underwent PD. Mean tumor size was 57.6 mm. Length of hospital stay was significantly shorter for EN compared with PP and PD groups (3.8 versus 6.2 versus 9.4 days, p < 0.001). There was a nonsignificant improvement in unplanned readmission [0% versus 8% versus 10.7% (p = 0.163)], 30-day mortality [0% versus 0.5% versus 0% (p = 0.359)], and 90-day mortality [0% versus 0.5% versus 0% (p = 0.363)] between EN, PP, and PD groups. Survival analyses showed no difference in OS when comparing EN versus PP (p = 0.443), and EN versus PD (p = 0317). Patients with LN metastases (p < 0.001) fared worse, and lymphovascular invasion, higher T category (T3-4) and M1 status were found as predictors for LN metastasis. EN may be considered for select patients leading to favorable outcomes. Because survival was worse in the rare cohort of patients with LN metastases, the predictors for LN metastasis identified here may aid in stratifying patients to EN versus resection.

Current literature addressing the treatment of solid pseudopapillary neoplasms (SPNs) of the pancreas is limited, particularly for patients with distant metastases. We aimed to define predictive indicators of survival in a large series of patients and assess the outcome of patients with distant metastases. The National Cancer Database was queried for patients diagnosed with SPNs of the pancreas between 1998 and 2011. Single predictor univariate analyses were performed on variables including demographics, tumor characteristics, and surgery outcomes, and multivariate Cox proportional hazards survival analysis was then completed with backward elimination. Overall, 340 patients were identified: 82% were female, median age was 39years, and 84% had no comorbidities. Patients undergoing any type of surgical resection experienced long-term survival (85% 8-year survival). Patients undergoing surgical resection (n=296) had superior survival (hazard ratio [HR] 21 for no surgery, p<0.0001), as did patients treated at academic centers and those with private insurance (HR 3.9, p=0.009; HR 4.9, p=0.007). Sex, age, tumor size, presence of lymph node metastases, positive surgical margins, and presence of distant metastases were not significant predictors of survival in multivariate analysis. Of 24 patients with distant metastases, seven were treated surgically and experienced long-term survival similar to that of patients without metastases treated surgically (HR 2, p=0.48). SPNs of the pancreas are rare neoplasms with excellent overall survival; however, in a low number of patients they metastasize. Of the few patients with metastatic disease selected for resection, most experienced long-term survival.

Solid Pseudopapillary Tumors of the Pancreas: Mayo Clinic 20 Years' Experience

A solid pseudopapillary neoplasm of the pancreas is an uncommon and 'enigmatic' pancreatic neoplasm of low malignant potential generally occurring in young women. The pathologic features of this tumor are characteristic, and adequate surgical intervention is associated with an excellent prognosis. We report the first case of combined solid pseudopapillary neoplasm and islet cell hyperplasia of the pancreas in the pediatric age group. A 16-year-old Saudi female presented to the Emergency Room with a history of frequent attacks of hypoglycemia. Radiologically, a mass in the tail of the pancreas was identified. The pre-operative diagnosis of insulinoma was suggested, and en bloc distal pancreatectomy with splenectomy was performed. A solid pseudopapillary neoplasm and islet cell hyperplasia of the tail of the pancreas was diagnosed by routine histology and by immunohistochemistry. The patient was treated successfully and is now in good health with regular follow-up for the last 13 months. In the pediatric age group, these tumors are very rare and can present as repeated episodes of hypoglycemia. This association sheds light on the histogenesis of solid pseudopapillary neoplasm of the pancreas and also allows appropriate and prompt management to be undertaken by the clinicians.

Solid pseudopapillary tumor of the pancreas is a rare epitelial tumor with a low potential for malignancy constitutes approximately 1% of all exocrine pancreatic tumors. We aimed to present a case with a solid pseudopapillary tumor of pancreas treated with distal pancreatectomy and splenectomy. A 18-year-old female patient was admitted to our general surgery department with a complaints of abdominal pain, distension and dysorexia. Abdominal computerized tomography revealed a solid mass located in the pancreatic tail. Distal pancreatectomy and splenectomy was performed. Histopathological examination revealed a solid pseudopapillary tumor of pancreas. Low volume pancreatic fistula was occurred in postoperative period and the patient was discharged on the ninth day. Solid pseudopapillary tumor of the pancreas a rare neoplasm which frequently effects the young women. Surgical resection is generally curative.

A review of the current evidence for the role of minimally invasive pancreatic surgery following neo-adjuvant chemotherapy

The minimally invasive surgical technique, like innovative technology, continues to evolve and be refined. New concepts in the surgery of benign and malignant gastrointestinal diseases will stimulate GI surgeons to deliver effective treatment in more minimally invasive procedures. 1. Laparoscopic gastrectomy for malignancy: With growing experience, laparoscopic gastric resections have become common procedures in certain high-volume hospitals and have encouraged the use of laparoscopy in the resection of gastric malignancy. However, the long-term oncologic outcome has not been established in large series. 2. Laparoscopic resection of colorectal cancer: Laparoscopically assisted colon resection was first reported in 1991. Since then laparoscopic resection of both benign and malignant colorectal diseases has been systematically evaluated. The cornerstone in the treatment of colorectal cancer establishes in surgical colon resection with a laparoscopic approach. Whereas the short-term outcome of laparoscopic versus open resection of colorectal malignancy has been evaluated, the long-term outcome still needs further evidence. 3. Bariatric surgery: The increasing use of bariatric procedures in the treatment of morbidly obese patients has undergone common practice. In general, restrictive, mal-absorptive, or combined restrictive and mal-absorptive procedures are the domain for the surgical treatment of diseased obesity. Both methods are the most common procedures for weight reduction at present. 4. Laparoscopic liver resection; Laparoscopic hepatectomy could avoid the disadvantages of open hepatectomy and is beneficial for the patient's life quality as a minimally invasive procedure. The indications for the laparoscopic approach are the tumor of less than 5cm, and it's location at the left or anterior sector superficially. The clinical long-term follow-up, either for laparoscopic or traditional liver resection for hepatocellular carcinoma, has been evaluated, and has failed to show significant differences between the laparoscopic and traditional groups. 5. Laparoscopic surgery in liver-donor hepatectomy: The most controversial topic in liver surgery has been the performance of living donor hepatectomy. The mortality of this procedure has varied from 0.5 to 1.0% based on reporting andperformance of hepatectomy: left lateral section, left hepatectomy or right hepatectomy. 6. Role of minimally invasive surgery in pancreatic diseases: Laparoscopic pancreatico-duodenectomy or central pancreatectomy for pancreatic tumor have been performed in specialized centers of the world. Additionally, studies that specifically evaluate and compare the oncologic outcomes of laparoscopic and open pancreatic resections are needed. In addition, natural orifice transluminal endoscopic surgery (NOTES) has the potential to redefine minimally invasive surgery. Application in human subjects is seen in sporadic reports. Rapid development of laparoscopic minimally invasive surgery and robot surgery will in all probability provide the greatest benefit for surgical science in the near future.