Adv Pediatr Surg.  2018 Dec;24(2):76-85. 10.13029/aps.2018.24.2.76.

Perioperative Outcomes and Surgical Indications of Minimally Invasive Pancreatectomy for Solid Pseudopapillary Tumor in Pediatric Patients

• Lee CW
• Namgoong J
• Kim DY
• Kim SC
• Lee SY
• Cho Y
• Kwon H

• KMID: 2429804
• DOI: http://doi.org/10.13029/aps.2018.24.2.76

Abstract

PURPOSE
We evaluated perioperative and long-term outcomes of minimally invasive surgery (MIS) and established indications of MIS in solid pseudopapillary tumor (SPT) in pediatric patients.
METHODS
From October 1992 to April 2018, 66 patients (age, < 18 years) diagnosed with SPT underwent either open pancreatectomy (OP) or MIS. Variables including postoperative complications and recurrence rates were retrospectively analyzed.
RESULTS
Thirty-five patients underwent open surgery and 31 underwent laparoscopic/robotic surgery. Mean tumor size in MIS was significantly smaller than that in OP (4.3±1.8 cm vs. 7.6±3.5 cm, p=0.005). There were 4 cases of open conversion from laparoscopic surgery because of vessel encasements (n=2), bleeding (n=1), and pancreatic ductal injury (n=1). Solitary pseudopapillary carcinoma was diagnosed in 6 patients. Recurrence was observed in 3 and 1 patients who underwent OP and MIS, respectively (p=0.634). Tumor size, mass size/abdominal diameter (MS/AD) ratio, and degree of the portal or superior mesenteric vein involvement were the most important indications for MIS.
CONCLUSION
MIS is being widely used in pediatric surgeries with increased expertise and safety, especially in pancreatic diseases. Careful patient selection for MIS in regards with parameters such as MS/AD ratio and vessel abutment might be a feasible choice.

Keyword

Solid pseudopapillary tumor; Minimally invasive surgery; Laparoscopic surgery; Robotic surgical procedures

MeSH Terms

Hemorrhage
Humans
Laparoscopy
Mesenteric Veins
Minimally Invasive Surgical Procedures
Pancreatectomy*
Pancreatic Diseases
Pancreatic Ducts
Patient Selection
Postoperative Complications
Recurrence
Retrospective Studies
Robotic Surgical Procedures

Figure

• 

  Fig. 1 Degree of PV or SMV compression. (A) PV compression model and (B) Grades 1–4 in computed tomography imaging. Grade 1, PV or SMV abutment; Grade 2, long-axis < short-axis ×2; Grade 3, long-axis > short-axis ×2; Grade 4, complete collapse; PV, portal vein; SMV, superior mesenteric vein.

• 

  Fig. 2 Operative procedure for SPT. SPT, solid pseudopapillary tumor; DP, distal pancreatectomy; SSDP, spleen-sparing distal pancreatectomy; PD, pancreatoduodenectomy; PPPD, pylorus-preserving pancreatoduodenectomy; MIS, minimally invasive surgery.

• 

  Fig. 3 MS/AD ratio of MIS along time. MS/AD, mass size/abdominal diameter; MIS, minimally invasive surgery.

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