Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.174
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
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that mainly affects young women.
To evaluate the impact of parenchyma-preserving surgical methods (PPMs, including enucleation and central pancreatectomy) in the treatment of SPN patients.
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.
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).
PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.
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.