Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2022; 14(2): 174-184
Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.174
Impact of parenchyma-preserving surgical methods on treating patients with solid pseudopapillary neoplasms: A retrospective study with a large sample size
Yu-Qiong Li, Shu-Bo Pan, Shu-Shu Yan, Zhen-Dong Jin, Hao-Jie Huang, Li-Qi Sun
Yu-Qiong Li, Shu-Bo Pan, Zhen-Dong Jin, Hao-Jie Huang, Li-Qi Sun, Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
Shu-Bo Pan, Department of Gastroenterology, Suzhou Science and Technology Town Hospital, Suzhou 215000, Jiangsu Province, China
Shu-Shu Yan, Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
Li-Qi Sun, Department of Gastroenterology, 72nd Group Army Hospital, Huzhou University, Huzhou 313000, Zhejiang Province, China
Author contributions: Li YQ, Pan SB and Yan SS contributed equally to this study and are co-first authors, were responsible for study design/planning, study conduct, data analysis and writing and revising the paper; Huang HJ and Sun LQ designed the study and they shared senior authorship; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Shanghai Changhai Hospital Ethics Committee (CHEC No. 2019-091).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Qi Sun, MD, Assistant Professor, Department of Gastroenterology, Changhai Hospital, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China. zjhzslqsmmu@qq.com
Received: October 7, 2021
Peer-review started: October 7, 2021
First decision: December 4, 2021
Revised: December 9, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: February 27, 2022
Processing time: 138 Days and 11.8 Hours
Abstract
BACKGROUND

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that mainly affects young women.

AIM

To evaluate the impact of parenchyma-preserving surgical methods (PPMs, including enucleation and central pancreatectomy) in the treatment of SPN patients.

METHODS

From 2013 to 2019, patients who underwent pancreatectomy for SPNs were retrospectively reviewed. The baseline characteristics, intraoperative index, pathological outcomes, short-term complications and long-term follow-up data were compared between the PPM group and the conventional method (CM) group.

RESULTS

In total, 166 patients were included in this study. Of them, 33 patients (19.9%) underwent PPM. Most of the tumors (104/166, 62.7%) were found accidentally. Comparing the parameters between groups, the hospital stay d (12.35 vs 13.5 d, P = 0.49), total expense (44213 vs 54084 yuan, P = 0.21), operation duration (135 vs 120 min, P = 0.71), and intraoperative bleeding volume (200 vs 100 mL, P = 0.49) did not differ between groups. Regarding pathological outcomes, tumor size (45 vs 32 mm, P = 0.07), Ki67 index (P = 0.53), peripheral tissue invasion (11.3% vs 9.1%, P = 0.43) and positive margin status (7.5% vs 6%, P = 0.28) also did not differ between groups. Moreover, PPM did not increase the risk of severe postoperative pancreatic fistula (3.8% vs 3.0%, P = 0.85) or tumor recurrence (3.0% vs 6.0%, P = 0.39). However, the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group (21.8% vs 3%, P = 0.024). CM was identified as an independent risk factor for pancreatic exocrine insufficiency (odds ratio = 8.195, 95% confident interval: 1.067-62.93).

CONCLUSION

PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.

Keywords: Solid pseudopapillary neoplasm; Surgical resection; Parenchyma-preserving method; Pancreatic exocrine insufficiency

Core Tip: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that mainly affects young women. The prognosis of SPN is excellent following complete surgical resection. However, the conventional surgical method is associated with a high rate of morbidity and a high rate of long-term endocrine/exocrine insufficiency due to the loss of pancreatic parenchyma. Our study identified a parenchyma-preserving surgical method (PPM) for SPN that appears to be feasible and safe for preserving the exocrine function of the pancreas. The risk of PPM did not increase the risk of severe postoperative pancreatic fistula or tumor recurrence. PPM should be taken into consideration in SPN patients with a long life expectancy.