Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Pancreatology. 2019 Jul;19(5):699-709. doi: 10.1016/j.pan.2019.06.008. Epub 2019 Jun 14.
Solid pseudopapillary neoplasms (SPN) are rare and represent approximately 4% of all cystic pancreatic tumors. The prognosis is excellent, although 10-15% of SPN patients show metastasis at the time of surgery or tumor recurrence during follow-up after pancreatectomy. Aim of the study was to analyze surgical management, risk factors for malignancy as well as long-term outcome and prognosis of this distinct tumor entity.
All patients with pancreatic resection for SPN between 10/2001 and 07/2018 in the authors' institution were identified from a prospective database. Clinicopathologic details, perioperative data and long-term follow-up results were retrospectively analyzed.
Fifty-two patients were identified, 44 (85%) of them were female and the median age was 29 years (IQR 9-71). Seven (13%) patients showed a malignant behaviour of SPN with N1 (n = 2) or M1 (n = 1) disease at resection; 5 patients developed tumor recurrence, after a median of 21 months. During follow-up time (median 54 months) all patients were alive, the 5- and 10-year rates for disease-free survival were 89.0% and 81.6%, respectively. Significant risk factors for recurrence were age <18 years (p = 0.0087) and parenchyma-preserving surgical approaches (p = 0.0006). The postoperative long-term outcome showed ECOG = 0-1 in all patients, with resection related exocrine insufficiency in 20 (41%) and diabetes mellitus in 2 (4%) patients.
Age < 18 years is a significant risk factor for malignancy in SPN, and parenchyma preserving resections harbor a significant risk for tumor recurrence. As recurrence may occur late, a systematic life-long follow-up should be performed.
实性假乳头状肿瘤（SPN）较为罕见，约占所有胰腺囊性肿瘤的 4%。尽管 10-15%的 SPN 患者在手术时或胰腺切除术后随访期间发生转移或肿瘤复发，但该肿瘤的预后良好。本研究旨在分析这种独特肿瘤实体的手术治疗、恶性肿瘤的危险因素以及长期结果和预后。
从作者机构的前瞻性数据库中确定了 2001 年 10 月至 2018 年 7 月期间因 SPN 行胰腺切除术的所有患者。回顾性分析了临床病理特征、围手术期数据和长期随访结果。
共确定了 52 例患者，其中 44 例（85%）为女性，中位年龄为 29 岁（IQR 9-71）。7 例（13%）患者的 SPN 表现出恶性行为，切除时存在 N1（n=2）或 M1（n=1）疾病；5 例患者在中位随访时间 21 个月后发生肿瘤复发。在随访期间（中位时间 54 个月）所有患者均存活，无病生存率的 5 年和 10 年率分别为 89.0%和 81.6%。复发的显著危险因素为年龄＜18 岁（p=0.0087）和保留胰腺实质的手术方式（p=0.0006）。所有患者的术后长期结局均为 ECOG=0-1，20 例（41%）患者存在与手术相关的外分泌功能不全，2 例（4%）患者患有糖尿病。
年龄＜18 岁是 SPN 发生恶性肿瘤的显著危险因素，保留胰腺实质的切除术存在肿瘤复发的显著风险。由于复发可能发生较晚，因此应进行系统的终身随访。
