Case reportLaparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas – Case report
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.
References (13)
- et al.
Laparoscopic pancreatic resection: is it worthwhile?
J Gastrointest Surg
(1997) - et al.
Laparoscopic and open distal pancreatic resection for benign pancreatic disease
J Gastrointest Surg
(2007) - et al.
Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature
J Am Coll Surg
(2005) Tumours of the pancreas
- et al.
Papillary epithelial neoplasm of pancreas in a child. Report of a case with electron microscopy
Cancer
(1970) - et al.
Laparoscopic distal pancreatectomy for Frantz's tumour in a child
Surg Endosc
(2003)
Cited by (13)
Minimally invasive hepatopancreatic and biliary surgery in children: a large centre experience and review of the literature
2022, HPBCitation Excerpt :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 Approaches to Pediatric Solid Tumors
2019, Surgical Oncology Clinics of North AmericaCitation 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, PancreatologyCitation 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.
Surgical outcomes of pancreaticoduodenectomy in young patients: A case series
2017, International Journal of SurgeryCitation 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 for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis
2017, Journal of Pediatric Surgery