Indications and outcomes of duodenum-preserving resection of the pancreatic head in children

Šnajdauf, J; Rygl, Michal; Petrů, O; J, Náhlovský; Frýbová, Barbora; Durilová, Marianna; Mixa, Vladimír; Keil, Radan; Kynčl, Martin; Kodet, Roman; Whitley, Adam

doi:10.1007/s00383-018-4410-6

Cited by 12 publications

(13 citation statements)

References 42 publications

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“…We align with previous studies that surgical management of pancreatic malignancy remains the mainstay of treatment for best long-term outcomes (1,7,11,12). We did not perform any duodenal sparing operations during resections of the pancreas head, which has shown success at other centers (13). Similarly, surgical management of pancreatic trauma was guided by extent and location of duct injury, as well as timing relative to onset of injury (14)(15)(16).…”

Section: Operative Proceduressupporting

confidence: 69%

A retrospective analysis of pancreas operations in children

Jones¹,

Zagory²,

Tatum³

et al. 2021

Transl Gastroenterol Hepatol

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Data regarding the indications for pancreatic operations and the ensuing outcomes is needed in this population in order to better inform clinical management and direct future studies. This report reviews all pancreas operations performed in children at a single institution. We desired to demonstrate the indications for these procedures and hypothesized that these operations are safe and effective in the pediatric population. We present the following article in accordance with the STROBE reporting checklist (available at http://dx.

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Section: Operative Proceduressupporting

confidence: 69%

A retrospective analysis of pancreas operations in children

Jones¹,

Zagory²,

Tatum³

et al. 2021

Transl Gastroenterol Hepatol

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“…Quantitative comparisons with PD have also demonstrated both short-term and long-term benefits (242). DPPHR demonstrated less new-onset DM (5%) compared to PD (15.7%) and less exocrine insufficiency (6.7% vs. 44.3%) (228).…”

Section: Figure 12mentioning

confidence: 98%

Solid pancreatic masses in children: A review of current evidence and clinical challenges

et al. 2022

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Pancreatic tumors in children are infrequently encountered in clinical practice. Their non-specific clinical presentation and overlapping imaging characteristics often make an accurate preoperative diagnosis difficult. Tumors are categorized as epithelial or non-epithelial, with epithelial tumors further classified as tumors of the exocrine or endocrine pancreas. Although both are tumors of the exocrine pancreas, solid pseudopapillary neoplasm is the most prevalent solid pancreatic tumor in children, while pancreatoblastoma is the most common malignant tumor. Insulinoma is the most common pediatric pancreatic tumor of the endocrine pancreas. Malignant tumors require a complete, often radical, surgical resection. However, pancreatic parenchyma-sparing surgical procedures are utilized for benign tumors and low-grade malignancy to preserve gland function. This review will discuss the epidemiology, pathophysiology, clinical and diagnostic characteristics, and management options associated with both common and rare solid pancreatic masses in children. We will also discuss current challenges encountered in their evaluation and treatment.

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“…While one report analyzing different pancreatic neoplasms in childhood found higher rates of exocrine insufficiency after PPPD, favoring Whipple surgery, others found no differences in this regard [ 5 , 36 , 37 ]. An alternative surgical approach for pancreatic head tumors is duodenum-preserving pancreatic head resection, which is less radical in its extent and is primarily intended for benign and low-grade malignant tumors [ 9 , 38 ]. In terms of postoperative sequelae, this method seems to offer an advantage, also with regard to the occurrence of endocrine insufficiencies [ 5 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Solid pseudopapillary neoplasms of the pancreas in childhood and adolescence—an analysis of the German Registry for Rare Pediatric Tumors (STEP)

Jentzsch,

Fuchs,

Agaimy

et al. 2023

Eur J Pediatr

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Solid pseudopapillary neoplasms (SPNs) are the most common entity among pediatric pancreatic tumors. Still, these are rare tumors with an annual incidence of 0.1–0.2/1,000,000, and little is known about their optimal treatment. This analysis aimed to increase knowledge about the occurrence and treatment strategies of SPN in childhood. Data regarding diagnostics, treatment, and outcome of children aged 0–18 years with SPN recorded in the German Registry for Rare Pediatric Tumors (STEP) were analyzed. Thirty-eight patients were identified with a median age of 14.5 years at diagnosis (range: 8–18) and a female preponderance (81.6%). The most frequent location of the tumor was the pancreatic tail. In histopathological and immunohistochemical examination, pseudopapillary, solid, and cystic lesions as well as expression of beta-catenin, progesterone receptors, and cyclin D1 were the most common findings. All patients underwent surgical resection. Most patients underwent open resection, predominantly tail resection for tumors in the tail region and pylorus-preserving pancreaticoduodenectomy for tumors in the head region. The main postoperative sequela was exogenous pancreatic insufficiency (23.7%), especially with SPN in the pancreatic head. No recurrence occurred during follow-up, although two patients underwent resection with microscopic residue.Conclusion: SPN of the pancreas in childhood are low-grade malignancies with usually favorable treatment outcomes. However, therapy can lead to relevant long-term sequelae. To prevent recurrence, complete surgical resection is recommended, sparing as much healthy pancreatic tissue as possible. Interdisciplinary collaboration between specialists is essential to optimize treatment. Molecular genetic analysis of these tumors could improve understanding of their genesis. What is Known:• Solid pseudopapillary neoplasms (SPNs) of the pancreas are very rare tumors in childhood.• Little is known about tumorigenesis, and there are no specific guidelines for treatment and follow-up in pediatric patients. What is New:• Characteristics, treatment, and outcome were comprehensively assessed in a large cohort of pediatric patients with SPN.• We propose recommendations for diagnosis, treatment, and follow-up of children with SPN, based on our analysis and considering published experience.

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Indications and outcomes of duodenum-preserving resection of the pancreatic head in children

Cited by 12 publications

References 42 publications

A retrospective analysis of pancreas operations in children

A retrospective analysis of pancreas operations in children

Solid pancreatic masses in children: A review of current evidence and clinical challenges

Solid pseudopapillary neoplasms of the pancreas in childhood and adolescence—an analysis of the German Registry for Rare Pediatric Tumors (STEP)

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