Abstract
Background: Solid pseudopapillary neoplasms (SPNs) are rare, low-grade, malignant neoplasms that can occur in pediatric patients. Although complete resection of the tumor is the principle treatment, SPN enucleation (EN) has been reported to be effective in children. This study aimed to examine the feasibility and safety of EN by comparing it with conventional pancreatectomy (CP), and to present the indications for its use in pediatric patients.Methods: We retrospectively reviewed the medical records of 66 patients who underwent surgery for SPN at our institution from October 1992 to April 2018. Surgical methods, postoperative complications, hospital stay, and recurrence were compared.Results: Of the 66 patients, 15 (22.7%) were treated with EN and 51 (77.3%) were treated with CP. The mean duration of EN operation was 262 min (±145 min) and of CP was 345 min (±195 min). There was no statistically significant difference between the two methods (P = 0.13). To objectively compare the mass size between patients, we introduced a tumor size/intraperitoneal width ratio, which also revealed no significant difference between the 2 surgery groups (P = 0.21). The EN group had one case of recurrence at the resection site. The complications observed were fluid collection, splenic infarctions, hematomas, pancreatic fistulas, portal vein thromboses, and chylous drainage, among which pancreatic fistulas were the most frequent followed by moderate-severe fistulas in the EN group (P < 0.001). The mean postoperative fasting time (EN 17.0 ± 8.7 days vs. CP 5.1 ± 3.3 days, P < 0.001) and mean hospital stay (EN 23.4 ± 10.0 days vs. CP 13.2 ± 6.5 days, P = 0.002) showed statistically significant differences.Conclusion: Compared with CP treatment, EN of SPNs in children has the disadvantages of prolonged fasting times and hospital stays to recover from moderate pancreatic fistulas. However, if appropriate indications are applied, EN can be considered a safe and effective surgical procedure for children.
Highlights
Solid pseudopapillary neoplasm (SPN) is a rare pancreatic disorder that was first introduced by Virginia Frantz in 1959 [1, 2]
This low-grade malignant neoplasm of the pancreas accounts for ∼1–3% of all cases of pancreatic neoplasms, occurring mostly in young women [3]
All patients were pathologically confirmed with SPN
Summary
Solid pseudopapillary neoplasm (SPN) is a rare pancreatic disorder that was first introduced by Virginia Frantz in 1959 [1, 2] This low-grade malignant neoplasm of the pancreas accounts for ∼1–3% of all cases of pancreatic neoplasms, occurring mostly in young women [3]. Complete resection of the tumor by current conventional pancreatectomy (CP) is the main treatment of choice, there are considerations of its use in children despite its safe implementation. This is due mainly to the fact that the procedure still has a high morbidity rate (40–60%) and causes loss of endocrine or exocrine function because of a significant loss of normal tissue [3, 5,6,7]. This study aimed to examine the feasibility and safety of EN by comparing it with conventional pancreatectomy (CP), and to present the indications for its use in pediatric patients
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