Dumitrascu Traian
Division of Surgical Oncology, Fundeni Clinical Institute, Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Fundeni Street no. 258, 022328 Bucharest, Romania.
Pediatr Rep. 2024 May 13;16(2):385-398. doi: 10.3390/pediatric16020033.
Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.
在多模式治疗的背景下，完整的手术切除已与诊断为胰腺母细胞瘤（PB）的儿童的优异长期生存率相关联。传统上，针对PB的根治性手术意味着进行标准的胰腺切除术，如胰十二指肠切除术和伴有脾切除术的远端胰腺切除术，这些手术可能会导致严重的长期胰腺功能缺陷。术后胰腺功能缺陷对儿童尤其值得关注，因为考虑到他们的预期寿命较长以及胰腺功能在其营养状况和生长中的重要作用，这些缺陷可能会干扰他们的发育。因此，保留器官的胰腺切除术，如保留脾脏的远端胰腺切除术和中央胰腺切除术，正在儿童特定肿瘤病理中出现。然而，关于保留器官的胰腺切除术在儿童PB根治性手术中的潜在作用的数据很少。基于文献数据，本综述旨在介绍儿童胰腺切除术的早期和晚期结果（包括长期缺陷及其对发育和生活质量的潜在影响），特别是针对PB的情况，并进一步探讨保留器官的胰腺切除术对PB的潜在作用。保留器官的胰腺切除术与更好的长期胰腺功能结果相关，特别是中央胰腺切除术，并且在不危及肿瘤学安全性的情况下，对儿童的发育和生活质量影响较小。在为儿童PB进行胰腺切除术时，不应忽视胰腺功能的长期保留。一部分PB患者可能受益于保留器官的胰腺切除术，特别是中央胰腺切除术，其肿瘤学结果与标准胰腺切除术相同，但对长期功能结果的影响明显较小。
