Ho In Geol, Ihn Kyong, Le Sung Min, Shin Soyong, Han Seok Joo
Division of Pediatric Surgery, Severance Children's Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Pediatr. 2024 Sep 17;12:1468276. doi: 10.3389/fped.2024.1468276. eCollection 2024.
Pancreatic neoplasms are rare among children and very few studies have reported on surgical outcomes for pediatric pancreatic neoplasms. Therefore, we aimed to describe patient and tumor characteristics and report on the surgical outcomes of pediatric pancreatic neoplasm.
In this retrospective single-center study, we reviewed and analyzed the data of patients who underwent surgery for pediatric pancreatic neoplasms at Severance Children's Hospital between January 2007 and December 2022. Clinical data including demographics, surgical procedures, and postoperative and long-term outcomes were evaluated.
A total of 28 patients underwent surgical treatment for pancreatic neoplasms with a median age of 11.7 years (range: 0.4-17.8). The most common histological diagnosis among benign tumors was solid pseudopapillary neoplasm (SPN), which occurred in 20 patients (71.4%). This was followed by a mucinous cyst, nesidioblastosis, pseudocyst, duplication cyst, and benign cyst, each occurring in one patient (3.5%). Regarding malignant tumors, pancreatoblastoma, solid pseudopapillary carcinoma, and malignant pheochromocytoma were noted in one patient each (3.5%). Tumor locations included the head in 4 patients (14.2%), the body in 7 (25%), and the tail in 16 (57.1%), and was diffuse in 1 (3.5%). The most common surgical resection range was distal pancreatectomy, found in 22 patients (78.5%), followed by pylorus-preserving pancreaticoduodenectomy, found in 2 (7.2%); duodenum-preserving pancreatic resection, central pancreatectomy, tumor enucleation, and near-total pancreatectomy were performed in one patient each (3.5%). Overall, 4 patients developed grade B or C postoperative pancreatic fistulas, and 1 experienced postoperative mortality due to uncontrollable bleeding. The mean follow-up period was 6.1 years (range: 1-15.6 years), during which no significant impact on growth after surgery was detected. Among the 20 patients with SPN, tumor rupture occurred in 4 (20%), among whom 2 experienced tumor recurrences.
Histological diagnosis of benign tumors was predominant in this case series and various extents of surgical resection were performed. Surgical treatment for pediatric pancreatic neoplasms appears to be safe and effective. However, considering the long-term prognosis of these patients, it is essential to determine the appropriate extent of surgical resection based on the location of the tumor.
胰腺肿瘤在儿童中较为罕见，很少有研究报道小儿胰腺肿瘤的手术结果。因此，我们旨在描述患者和肿瘤特征，并报告小儿胰腺肿瘤的手术结果。
在这项回顾性单中心研究中，我们回顾并分析了2007年1月至2022年12月期间在Severance儿童医院接受小儿胰腺肿瘤手术的患者数据。评估了包括人口统计学、手术程序以及术后和长期结果在内的临床数据。
共有28例患者接受了胰腺肿瘤手术治疗，中位年龄为11.7岁（范围：0.4 - 17.8岁）。良性肿瘤中最常见的组织学诊断是实性假乳头状瘤（SPN），有20例患者（71.4%）。其次是黏液性囊肿、胰岛母细胞瘤、假性囊肿、重复囊肿和良性囊肿，各有1例患者（3.5%）。恶性肿瘤方面，各有1例患者（3.5%）被诊断为胰母细胞瘤、实性假乳头状癌和恶性嗜铬细胞瘤。肿瘤位置包括胰头4例（14.2%）、胰体7例（25%）、胰尾16例（57.1%），弥漫性1例（3.5%）。最常见的手术切除范围是远端胰腺切除术，22例患者（78.5%）采用此术式，其次是保留幽门的胰十二指肠切除术，2例（7.2%）；保留十二指肠的胰腺切除术、全胰切除术、肿瘤剜除术和近全胰切除术各有1例患者（3.5%）采用。总体而言，4例患者发生了B级或C级术后胰瘘，1例因无法控制的出血术后死亡。平均随访期为6.1年（范围：1 - 15.6年），在此期间未发现手术对生长有显著影响。在20例SPN患者中，4例（20%）发生肿瘤破裂，其中2例出现肿瘤复发。
在本病例系列中，良性肿瘤的组织学诊断占主导，进行了各种程度的手术切除。小儿胰腺肿瘤的手术治疗似乎是安全有效的。然而，考虑到这些患者的长期预后，根据肿瘤位置确定合适的手术切除范围至关重要。
