Clinical presentation and comparison of surgical outcome for segmental resection vs. Whipple's procedure for solid pseudopapillary tumor: Report of six new cases & literature review of 321 cases |
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| Affiliation: | 1. Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA;2. William Beaumont Hospital, Royal Oak, MI, USA;3. Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA;1. Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Lab of Cancer Treatment and Prevention, Tianjin 300060, China;2. 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, The Key Laboratory of Hormones and Development (Ministry of Health), Department of Diabetic Foot, The Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China;1. Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France;2. Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France |
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| Abstract: | AimReport 6 new cases of solid-pseudopapillary-pancreatic-tumor, comprehensively review 321 cases reported in American literature, and compare outcomes for segmental resection vs.. Whipple's procedure.MethodsCases of solid-pseudopapillary-tumor at William Beaumont Hospital, 1999–2011, identified by computerized analysis of pathology reports. Comprehensive review of all American cases identified by computerized literature review. Segmental resection includes open/laparoscopic central pancreatectomy and anatomic distal pancreatectomy, but excludes enucleation.ResultsSix cases of solid-pseudopapillary-pancreatic-tumors (0.5% of all solid pancreatic lesions), occurred during 1999–2011 at the hospital. Mean age at diagnosis = 27.7 years. All 6 were female. All patients had abdominal pain. Mean symptom duration = 10.0 days. All patients had normal routine blood tests. Mean APACHE II score at diagnosis = 1.8. All six patients had single heterogeneous lesions, with cystic/solid components. All patients underwent surgery: segmental resection-4, Whipple's procedure-2. Tumors were uniformly diagnosed by surgically resected tissue. Mean tumor size = 5.7 cm. Mean postoperative length of stay = 4.0 days for segmental resection (N = 4) vs. 14.0 days for Whipple's procedure (N = 2). All 6 patients are alive and well to-date, without evident local recurrence or metastasis. In a literature review, 45 patients undergoing Whipple's procedure versus 34 patients undergoing segmental resection, had significantly longer mean postoperative hospitalization (16.4 vs. 4.3 days, p = 0.01), and had increased unadjusted mortality (20.2% vs. 2.2%, p = 0.018). However, this mortality difference became insignificant when adjusting for longer mean follow-up of Whipple's procedure patients (Kaplan–Meier-survival-curve, p = 0.75).ConclusionsThis work suggests segmental resection of these pancreatic tumors localized to the body/tail may have a better surgical outcome than Whipple's procedure for tumors localized to the pancreatic head. Further studies are necessary. |
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| Keywords: | Solid pseudopapillary tumor Nonneuroendocrine pancreatic tumor Pancreatic neoplasms Surgical outcomes Segmental resection Whipple's procedure Surgical mortality Oncology Prognosis |
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