Solid Pseudopapillary Neoplasm: Single Center Experience

Abstract

Purpose: Solid Pseudopapillary Neoplasm(SPN) was first described by Frantz in 1959. SPNs are very rare tumors about 0.3-2.7% of all pancreatic tumors, and therefore the management of disease is still controversial. In this study, we aimed to present our experience together with literature review. Method: We reviewed hospital medical records from January 2005 to February 2020. Patient data was collected retrospectively. Study was approved by local Ethics Committee. Results: In our institution, there were 15 SPN patients (4.7%) among 319 pancreatic mass. Median age was 36 (mean 35.6, range 11-70) and all were female. Median follow-up was 81 months (mean 74.6, range 18-160) and there was no long term mortality. Eight distal pancreatectomy (DP), five pancreaticoduodenectomy (PD), one total pancreatectomy (TP) and one central pancreatectomy (CP) were performed. Distant metastases or peritoneal implants were not observed during surgery and only one patient had lymph node metastasis. There was no postoperative mortality and one reoperation was performed after DP due to pancreatic leak. Abdominal abscess (two patients) and pancreatic fistulas (three patients) developed as postoperative complications. Although four of the patients (3 DP, 1 PD) had microscopic tumor residual on surgical margin, distant metastasis or local recurrence were not observed at any of the patients during long term follow-up. Conclusion: Even-though there is a risk of distant metastasis, there have been no consensus for surgical management of SPN. Many studies suggest that surgical treatment should be chosen according to oncological principals similar to other pancreatic malignancies. Consistent with the literature, we performed oncologic surgery for SPN according to tumor location in the pancreas. In our experience, SPN has excellent prognosis even with positive surgical margin, so pancreas-sparing surgeries such as enucleation may be considered in anatomically suitable patients. However prospective randomized controlled trials are still missing due to rarity of SPN. Designing multi-centric studies may overcome this problem in the future.