The optimal surgical approach for solid pseudopapillary neoplasm of the pancreas: A retrospective study

Year 2022, Volume: 39 Issue: 2, 477 - 481, 18.03.2022

Oğuzhan Özşay Mehmet Can Aydın

Abstract

The most effective surgical approach for solid pseudopapillary neoplasms (SPNs) remains unclear. We conducted a retrospective study of 14 patients diagnosed with SPN between September 2013 and October 2021. Thirteen patients were female, and the median age was 39.5 (18–63) years. The mean tumour diameter was 5.2 ± 2.2 (range, 2–10) cm. The type of surgery was decided based on the tumour location and the extrapancreatic invasion status. The conservative (organ-preserving) surgical procedure was spleen-preserving distal pancreatectomy (n=3). The radical surgical procedures included pancreaticoduodenectomy, with either venous reconstruction (n=2) or without (n=4), and distal pancreatectomy + splenectomy (n=5); similar to performed for pancreatic cancer regional lymphadenectomy was not performed. Tumour resection margins were free in all patients. There were no cases of lymph node metastasis, but the number of examined lymph nodes was significantly higher in the radical surgery group (p=0.03). A female patient developed multiple liver metastases one year after distal pancreatectomy + splenectomy. Her number of examined lymph nodes was the highest of the cohort (n=24). The mean follow-up time was 40 ± 23.5 months. All patients were alive at the end of the study. In conclusıon; necessity for radical surgery may be associated with malignant behaviour. Therefore, the extent of the surgical operation may be expanded during radical procedures for SPNs.

Keywords

conservative surgery, optimal surgical approach, radical surgery, solid pseudopapillary neoplasm

References

• 1. Papavramidis, T., Papavramidis, S., 2005. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J. Am. Coll. Surg. 200, 965-972.
• 2. Wang, X.-G., Ni, Q.-F., Fei, J.-G., Zhong, Z.-X., Yu, P.-F., 2013. Clinicopathologic features and surgical outcome of solid pseudopapillary tumor of the pancreas: analysis of 17 cases. World J. Surg. Oncol. 11, 1-6.
• 3. Law, J.K., Ahmed, A., Singh, V.K., Akshintala, V.S., Olson, M.T., Raman, S.P., et al., 2014. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas. 43, 331.
• 4. Reddy, S., Wolfgang, C.L., 2009. Solid pseudopapillary neoplasms of the pancreas. Adv. Surg. 43, 269-282.
• 5.Machado, M.C., Machado, M.A.C., Bacchella, T., Jukemura, J., Almeida, J.L., Cunha, J.E., 2008. Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients. Surgery. 143, 29-34.
• 6.Ganeshan, D.M., Paulson, E., Tamm, E.P., Taggart, M.W., Balachandran, A., Bhosale, P., 2013. Solid pseudo-papillary tumors of the pancreas: current update. Abdom. Imaging. 38, 1373-1382.
• 7.Kang, C.M., Choi, S.H., Kim, S.C., Lee, W.J., Choi, D.W., Kim, S.W., 2014. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann. Surg. 260, 348-355.
• 8.Chung, Y.E., Kim, M.-J., Choi, J.-Y., Lim, J.S., Hong, H.-S., Kim, Y.C., et al., 2009. Differentiation of benign and malignant solid pseudopapillary neoplasms of the pancreas. J. Comput. Assist. Tomogr. 33, 689-694.
• 9.Butte, J.M., Brennan, M.F., Gönen, M., Tang, L.H., D’Angelica, M.I., Fong, Y., et al., 2011. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J. Gastrointest. Surg. 15, 350-357.
• 10.Yu, P., Cheng, X., Du, Y., Yang, L., Xu, Z., Yin, W., et al., 2015. Solid pseudopapillary neoplasms of the pancreas: a 19-year multicenter experience in China. J. Gastrointest. Surg. 19, 1433-1440.
• 11.Bostancı, E.B., Öter, V., Binarbaşı, C., Turhan, N., Özer, İ., Ulaş, M., et al., 2016. Surgical outcomes of solid pseudopapillary neoplasm of the pancreas: a single institution's experience of 16 cases. Arch. Iran Med. 19, 30-34.
• 12.Lubezky, N., Papoulas, M., Lessing, Y., Gitstein, G., Brazowski, E., Nachmany, I., et al., 2017. Solid pseudopapillary neoplasm of the pancreas: management and long-term outcome. Eur. J. Surg. Oncol (EJSO). 43, 1056-1060.
• 13.Yepuri, N., Naous, R., Meier, A.H., Cooney, R.N., Kittur, D., Are, C., et al., 2020. A systematic review and meta-analysis of predictors of recurrence in patients with Solid Pseudopapillary Tumors of the Pancreas. HPB (Oxford). 22, 12-19.
• 14.Tol, J.A., Gouma, D.J., Bassi, C., Dervenis, C., Montorsi, M., Adham, M., et al., 2014. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 156, 591-600.
• 15.Bassi, C., Marchegiani, G., Dervenis, C., Sarr, M., Hilal, M.A., Adham, M., et al., 2017. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 161, 584-591.
• 16.Dindo, D., Demartines, N., Clavien, P.-A., 2004. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240, 205.
• 17.Dinarvand, P., Lai, J., 2017. Solid pseudopapillary neoplasm of the pancreas: a rare entity with unique features. Arch. Pathol. Lab. Med. 141, 990-995.
• 18.Slidell, M.B., Chang, D.C., Cameron, J.L., Wolfgang, C., Herman, J.M., Schulick, R.D., et al., 2008. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann. Surg. Oncol. 15, 165-174.
• 19.Goh, B.K., Tan, Y.M., Cheow, P.C., Alexander Chung, Y.F., Chow, P.K., Wong, W.K., et al., 2007. Solid pseudopapillary neoplasms of the pancreas: an updated experience.J. Surg. Oncol. 95, 640-644.
• 20.Jani, N., Dewitt, J., Eloubeidi, M., Varadarajulu, S., Appalaneni, V., Hoffman, B., et al., 2008. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy. 40, 200-203.
• 21.Li, D.L., Li, H.S., Xu, Y.K., Wang, Q.S., Chen, R.Y., Zhou, F., 2018. Solid pseudopapillary tumor of the pancreas: clinical features and imaging findings. Clin Imaging. 48, 113-121.