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Clinical Trial
. 2020 Sep;67(9):e28425.
doi: 10.1002/pbc.28425. Epub 2020 Jul 13.

Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study

Sanjeev A Vasudevan  1 , Tu-Anh N Ha  1 , Huirong Zhu  1 , Todd E Heaton  2 , Michael P LaQuaglia  2 , Joseph T Murphy  3 , Wesley E Barry  4 , Catherine Goodhue  4 , Eugene S Kim  4 , Jennifer H Aldrink  5 , Stephanie F Polites  6 , Harold J Leraas  7 , Henry E Rice  7 , Elisabeth T Tracy  7 , Timothy B Lautz  8 , Riccardo A Superina  8 , Andrew M Davidoff  9 , Max R Langham Jr  9 , Andrew J Murphy  9 , Andreana Bütter  10 , Jacob Davidson  10 , Richard D Glick  11 , James Grijalva  12 , Kenneth W Gow  12 , Peter F Ehrlich  13 , Erika A Newman  13 , Dave R Lal  14 , Marcus M Malek  15 , Annie Le-Nguyen  16 , Nelson Piché  16 , David H Rothstein  17 , Scott S Short  18 , Rebecka Meyers  18 , Roshni Dasgupta  6
Affiliations
Clinical Trial

Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study

Sanjeev A Vasudevan et al. Pediatr Blood Cancer. 2020 Sep.

Abstract

Background: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD).

Methods: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected.

Results: Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival.

Conclusion: This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.

Keywords: Whipple; children; pancreatic neoplasms; pancreaticoduodenectomy; pancreatoblastoma; solid pseudopapillary tumor of the pancreas.

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Conflict of interest statement

Conflicts of Interest

No financial disclosures or conflicts of interest to report.

Figures

Figure 1:
Figure 1:
Kaplan Meier curve for recurrence with 95% Hall-Wellner bands Red line = solid pseudopapillary tumor of the pancreas (SPN) diagnosis Blue line = malignant non-SPN diagnosis
Figure 2:
Figure 2:
Kaplan Meier curve for death with 95% Hall-Wellner bands Red line = solid pseudopapillary tumor of the pancreas (SPN) diagnosis Blue line = malignant non-SPN diagnosis
See this image and copyright information in PMC

Comment in

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