Machado Marcel C C, Machado Marcel Autran C, Bacchella Telesforo, Jukemura José, Almeida José L, Cunha José E M
Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
Surgery. 2008 Jan;143(1):29-34. doi: 10.1016/j.surg.2007.07.030. Epub 2007 Nov 5.
Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients.
The medical records of 34 consecutive patients with pancreatic solid pseudopapillary neoplasms between 1990 and 2006 were reviewed. Whenever feasible, organ-preserving operation was performed. Statistical analysis was performed using chi-square and Student t test.
There were 27 women (79%) and seven men (21%) with median age of 23 years. Mean diameter of the tumor was 7 cm. Tumor size tended to be smaller in patients treated in more recent years. Conservative surgery was possible in 11 patients including spleen-preserving distal pancreatectomy in 3, central pancreatectomy in 5, and enucleation in 3 patients. Median hospital stay was 11 days, morbidity rate was 62%, including 17 patients with grade A pancreatic fistula, and there was no operative mortality. Mean follow-up time was 84 months. Tumor recurred in 2 patients (6%). Overall late morbidity rate was 12%. At the time of diagnosis, age was (x +/- SD) higher among male patients (25 +/- 2 years vs 37 +/- 7 years; P <.05) with no difference in tumor size. The neoplasms were more aggressive in male patients; therefore, conservative surgery was less likely. There was no correlation between tumor aggressiveness and age of the patient or size of tumor.
This is the first single center study to demonstrate that solid pseudopapillary neoplasms in male patients have distinct patterns of onset and aggressiveness when compared with female patients. Although valid prognostic criteria are still lacking, it appears that male patients may be best treated by more radical operation and should be observed more closely during follow-up.
胰腺实性假乳头状瘤是一种具有低转移潜能的独特胰腺肿瘤。本研究探讨男性和女性患者的临床差异及预后。
回顾了1990年至2006年间34例连续性胰腺实性假乳头状瘤患者的病历。只要可行，就进行保留器官手术。采用卡方检验和学生t检验进行统计分析。
有27名女性（79%）和7名男性（21%），中位年龄为23岁。肿瘤平均直径为7厘米。近年来接受治疗的患者肿瘤大小往往较小。11例患者可行保守手术，包括3例保留脾脏的胰体尾切除术、5例中段胰腺切除术和3例肿瘤剜除术。中位住院时间为11天，发病率为62%，其中17例为A级胰瘘患者，无手术死亡。平均随访时间为84个月。2例患者（6%）肿瘤复发。总体晚期发病率为12%。诊断时，男性患者年龄（x±标准差）较高（25±2岁对37±7岁；P<.05），肿瘤大小无差异。男性患者的肿瘤侵袭性更强；因此，保守手术的可能性较小。肿瘤侵袭性与患者年龄或肿瘤大小之间无相关性。
这是第一项单中心研究，表明男性患者的胰腺实性假乳头状瘤与女性患者相比具有不同的发病模式和侵袭性。尽管仍缺乏有效的预后标准，但似乎男性患者最好采用更根治性的手术治疗，并且在随访期间应更密切观察。
