Laparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas – Case report

doi:10.1016/j.pan.2014.06.005

Pancreatology

Volume 14, Issue 6, November–December 2014, Pages 550-552

https://doi.org/10.1016/j.pan.2014.06.005 Get rights and content

Abstract

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumour commonly seen in young women without significant clinical features. SPN is usually a lowgrade malignant neoplasm which warrants resection. Recurrence and metastasis is seen rarely after complete resection. Pancreaticoduodenectomy is indicated for SPN situated in head of the pancreas which is generally performed by open approach. Laparoscopic pancreaticoduodenectomy (LPD) is difficult to perform for this condition because of smaller size of pancreatic and hepatic ducts more so in paediatric population. We report a case of 12 years old girl having SPN arising from head of the pancreas. She underwent laparoscopic pylorus preserving pancreaticoduodenectomy. Post-operative period was uneventful. Histological examination of resected specimen confirmed diagnosis of SPN. At 6 months follow up, she was doing well without any recurrence. To best of our knowledge, no case of LPD in paediatric patients is reported in literature available to us.

Introduction

Solid pseudopapillary neoplasm (SPN) is one of the rare primary tumours of the pancreas, first described by Frantz [1] in 1959. It mainly affects young females in the second and third decades. It has a low malignant potential with very low risk of recurrence or metastasis after complete resection. Recommended definitive treatment of pancreatic SPN is complete resection, with the surgical approach depending on both tumour location and size. The first surgical resection of a pancreatic SPN was performed by Grosfeld and described by Hamoudi in 1970 [2]. Carricaburu [3] reported the first case of laparoscopic SPN resection (distal pancreatectomy) in a child. Since then only few case reports and small case series of open pancreaticoduodenectomy for SPN in children have been published.

Laparoscopic resection of the pancreas was first reported in the literature in the early 1990s. The first laparoscopic pancreaticoduodenectomy (LPD) was performed in 1994 [4]. It was followed by few reports from centres with experience in performing this procedure and the initial reported clinical outcomes of LPD had been unsatisfactory [5], [6]. We started LPD after gaining sufficient experience in other major laparoscopic procedures and reported our outcomes which were comparable to open approach [7]. LPD, with known advantages of laparoscopic surgery over open pancreaticoduodenectomy, may be acceptable as an alternative to open procedure if technical feasibility and safety can be ensured with acceptable morbidity and mortality for the treatment of benign or low-grade malignant lesions like SPN. To best of our knowledge, no case report of LPD in children has been published so far.

Section snippets

Case report

A 12 years girl without any significant medical or surgical history presented to her family physician for pain in upper abdomen with vomiting for 2 weeks. Ultrasound (US) abdomen revealed a mass lesion in head of the pancreas. So she was referred to us for further management. General and per abdomen examinations were unremarkable. Blood investigations including tumour markers CEA and CA 19-9 were within normal limits. MDCT abdomen with triple phase showed large well defined relatively hypodense

Discussion

Laparoscopic surgical techniques have grown rapidly in last decade due to development in laparoscopic instruments, energy sources to control bleeding and growing laparoscopic experience. Laparoscopic pancreatic surgery is still not universally practiced though laparoscopic distal pancreatic resections are now proven to be safe and readily feasible [8], [9]. LPD is a complex procedure with technical difficulties during dissection because of nearby large vessels and complex reconstruction. Many

Conclusion

Solid pseudopapillary neoplasm is a rare tumour of the pancreas. Pancreaticodudenectomy is recommended treatment for this tumour located in head of the pancreas. Laparoscopic approach can be an alternative if expertise is available even in paediatric patients.

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Cited by (13)

Minimally invasive hepatopancreatic and biliary surgery in children: a large centre experience and review of the literature
2022, HPB
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Another example could be represented by the surgical stapler, which always requires a 12 mm trocar. Likewise, it has not yet been defined the “gold standard” technique for MIS for paediatric HPB diseases.15–46 Therefore, we believe that the best approach depends on the surgeon's expertise.
Minimally invasive surgery (MIS) for hepatopancreatic and biliary (HPB) diseases has been widely used in adults, while in children, its application is limited due to its complexity. Herein, we report the experience of MIS for paediatric HPB diseases and literature review.
All children (≤18 years-old) undergoing major HPB operations by MIS during January 2017–June 2020 in our institution were prospectively enrolled.
Out of 139 children operated on for HPB diseases with MIS, 26 (18.7%) patients (age: 11 (1–17) years-old; weight: 41.9 (10.7–75.5) kg) underwent major HPB surgery, including 11 pancreatic resections and 15 liver resections, all performed by a full-laparoscopic-technique. Four (15.3%) surgeries were electively converted to an open-technique for safer operative management. None required a blood transfusion. The median hospital admission was 6 days. Post-operatively, all patients had early mobilization and good recovery. Two (7.7%) patients experienced post-operative complications requiring radiological intervention. Oncological radical resection (R0) was achieved in all tumours, and after 2 years, all children were free of tumour recurrence.
MIS for HPB surgery is safe and feasible in children, with less surgical trauma, short hospital-stay and better aesthetic results. An adequate learning curve in specialized centres is essential for good outcomes.
Robotic pancreatectomy for solid pseudopapillary tumors in the pancreatic head: A propensity score-matched comparison and analysis from a single center
2020, Asian Journal of Surgery
Robotic surgery is the most advanced minimally invasive technique for the treatment of complicated solid pseudopapillary tumors (SPT). The aim of this study is to evaluate feasibility of robotic surgery for the treatment of SPTs in the pancreatic head.
A retrospective analysis of the clinical data of 83 SPTs in pancreatic head was conducted. Clinical characteristics were extracted and propensity score matching (PSM) was used to compare and evaluate mid-term outcomes of the two techniques.
Pancreaticoduodenectomy (PD), duodenum-preserving partial pancreatic head resection (DPPHR-P) and tumor enucleation (En) were performed in 51, 24, and 8 patients, respectively. The robotic approach was associated with a significantly lower volume of blood loss, lower need for transfusion, and faster time to post-surgery recovery. Major complications and costs were comparable for both techniques.
A robotic approach provides an alternative to open surgery for SPTs in the pancreatic head without increasing the incidence of clinically relevant pancreatic fistula (CRPF) or other major complications and with good patient outcomes.
Minimally Invasive Approaches to Pediatric Solid Tumors
2019, Surgical Oncology Clinics of North America
Citation Excerpt :
Pancreatic tumors are rare in children occurring in fewer than 1 in 500,000 children and are comprised principally of pancreatoblastoma in the infant population and solid pseudopapillary tumors (SPT) and islet cell tumors in older children. Although anecdotal case reports of successful minimally invasive resections of pancreatic lesions in children have been reported (including several isolated reports of laparoscopic pancreaticoduodenectomy and laparoscopic central pancreatectomy) there is only one larger multicenter study.17,20,46–51 In this study, Esposito and colleagues51 reported on the results of laparoscopic resection of 15 pancreatic tumors at six large pediatric centers over a 5-year period.
Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care center from south India
2017, Pancreatology
Citation Excerpt :
The median follow-up period was 31 months (3–62 months). During the follow-up period, one pediatric patient (previously published as case report [11]), developed biliary stricture and was managed with laparoscopic stricturoplasty. None of the patients developed any recurrences or metastases.
Solid pseudo papillary neoplasm (SPN) of the pancreas which predominantly affects young women is a relatively indolent entity with favorable prognosis. Resection through minimal access approach helps to achieve better short term benefits. The aim of this study is to describe our experience in laparoscopic management of this disease.
A retrospective review of our prospectively maintained database revealed that 17 patients with SPN were managed with surgical resection between March 2009 and October 2016. The clinical data of these patients were then analyzed.
Among the 17 cases of SPN, 14 were females and 3 were males. The mean age at presentation was 26.1 years (11–46 years). The most common presenting symptom was an abdominal pain (n = 10; 58.8%). A tumor was incidentally detected in 5 patients. The neoplasm was localized in the pancreatic head/neck in 6 patients and in the body/tail in 11. The median diameter of the tumors was 7.5 cm (2–13 cm). Five patients underwent pancreaticoduodenectomy, 10 had distal pancreatectomy, while median pancreatectomy or enucleation was performed in one each. All the patients were offered laparoscopic surgery; one distal pancreatectomy was converted to open in view of bleeding. The median length of stay was 7 days (5–28 days). The patients were followed up for a median period of 31 months (3–62 months).
SPN is a rare neoplasm with low malignant potential and has an excellent prognosis. In our experience, laparoscopic surgical resection is safe and feasible, even for larger lesions.
Surgical outcomes of pancreaticoduodenectomy in young patients: A case series
2017, International Journal of Surgery
Citation Excerpt :
These risk factors included patient's age, body mass index, pre-operative jaundice, intra-operative blood loss, consistency of the pancreas, pancreatic duct diameter, type of pancreatic reconstruction, use of somatostatin analogues and surgeon's experience [4–7]. As pancreatic and periampullary pathologies are uncommon in young populations, Pancreaticoduodenectomy (PD) is not a frequently performed procedure in pediatric and young adults [8–10]. In a statistical review performed by the National Cancer institute, the incidence of pancreatic tumors in young population (below 19 years) is 0.19 per million populations [11,12].
Pancreaticoduodenectomy (PD) is a complex procedure for management periampullary neoplasms The aim of our work is to report the surgical outcomes after PD in young adult (YA) (<35 years) and to compare it to a adult patients who underwent PD.
We retrospectively analyzed the data of all patients who underwent PD in the period from January 1993 to December 2016. The primary outcome was the rate of total postoperative complications. Secondary outcomes included postoperative pathology, exocrine and endocrine function and survival rate.
58/975 patients (5.9%) were YA and the majority of them were females. The incidence of post-operative complications in the YA was comparable to that in the adult group. Delayed gastric emptying developed significantly in adult group than YA group (0.008). The overall survival was significantly higher in the YA (P = 0.0001). The most common pathology in the YA was adenocarcinoma (41.4%) and solid pseudopapillary tumor (SPT) (29.3%). No significant difference as regards postoperative pancreatic exocrine and endocrine function in both groups.
PD in YA when performed in tertiary centers with good surgical experience is safe. The most common pathological diagnosis in the YA was adenocarcinoma followed by SPT.
Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis
2017, Journal of Pediatric Surgery
While pancreaticoduodenectomy (PD) has been extensively studied in adults, there are few data pertaining specifically to pediatric patients. We retrospectively analyzed PD-associated morbidity and mortality in pediatric patients.
Our analytic cohort included all consecutive patients ≤ 18 years of age treated at our institution from 1993 to 2015 who underwent PD. Patient data (demographics, disease characteristics, surgical and adjuvant treatment, length of hospital stay, and postoperative course) were extracted from the medical records.
We identified 12 children with a median age of 9 years (7 female, 5 male). Final diagnoses were pancreatoblastoma (n = 3), solid pseudopapillary tumor (n = 3), neuroblastoma (n = 2), rhabdomyosarcoma (n = 2), and neuroendocrine carcinoma (n = 2). Four patients underwent PD for resection of recurrent disease. 75% (9/12 patients) received neoadjuvant therapy. The median operative time was approximately 7 hours with a mean blood loss of 590 cm³. The distal pancreas was invaginated into the posterior stomach (n = 3) or into the jejunum (n = 5) or was directly sewn to the jejunal mucosa (n = 4). There were no operative deaths. There were 4 patients (34%) with grade II complications, 1 with a grade IIIb complication (chest tube), and 1 with a grade IV complication (reexploration). The most common long-term morbidity was pancreas exocrine supplementation (n = 10; 83%). Five patients (42%) diagnosed with either solid pseudopapillary tumor or rhabdomyosarcoma are currently alive with a mean survival of 77.4 months.
Pancreaticoduodenectomy is a feasible management strategy for pediatric pancreatic malignancies and is associated with acceptable morbidity and overall survival. Long-term outcome is mostly dependent on histology of the tumor.
Level IV; retrospective study with no comparison group.

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Case reportLaparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas – Case report

Abstract

Introduction

Section snippets

Case report

Discussion

Conclusion

J Gastrointest Surg

J Gastrointest Surg

J Am Coll Surg

Tumours of the pancreas

Papillary epithelial neoplasm of pancreas in a child. Report of a case with electron microscopy

Cancer

Laparoscopic distal pancreatectomy for Frantz's tumour in a child

Surg Endosc

Case report
Laparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas – Case report