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13-03-2024 | Pancreatoduodenostomy | Pancreatic Tumors

Solid Pseudopapillary Tumor of the Pancreas: Is Enucleation Safe?

Authors: Oscar Salirrosas, MD, Eduardo A. Vega, MD, Elena Panettieri, MD, Hamed Harandi, MD, Olga Kozyreva, MD, Shree Ghanta, MD, Claudius Conrad, MD, PhD, FACS, FSSO

Published in: Annals of Surgical Oncology | Issue 6/2024

Abstract

Background

While solid pseudopapillary tumor (SPT) of the pancreas are oncologically low-risk tumors, their resection with pancreaticoduodenectomy (PD) or partial pancreatectomy (PP) carries a significant risk for morbidity. To balance the favorable prognosis with the surgical morbidity of pancreas resection, this study explores the oncologic safety of enucleation (EN).

Patients and Methods

The National Cancer Database (NCDB) was queried for resected SPT from January 2004 through December 2020. Perioperative outcomes and survival were analyzed with Kruskal–Wallis tests, and Kaplan–Meier analysis (with log-rank test). Survival analysis was performed to compare patients with and without lymph node (LN) metastases and binary logistic regression for predictors of LN metastasis.

Results

A total of 922 patients met inclusion criteria; 18 patients (2%) underwent EN, 550 (59.6%) underwent PP, and 354 (38.4%) underwent PD. Mean tumor size was 57.6 mm. Length of hospital stay was significantly shorter for EN compared with PP and PD groups (3.8 versus 6.2 versus 9.4 days, p < 0.001). There was a nonsignificant improvement in unplanned readmission [0% versus 8% versus 10.7% (p = 0.163)], 30-day mortality [0% versus 0.5% versus 0% (p = 0.359)], and 90-day mortality [0% versus 0.5% versus 0% (p = 0.363)] between EN, PP, and PD groups. Survival analyses showed no difference in OS when comparing EN versus PP (p = 0.443), and EN versus PD (p = 0317). Patients with LN metastases (p < 0.001) fared worse, and lymphovascular invasion, higher T category (T3–4) and M1 status were found as predictors for LN metastasis.

Conclusions

EN may be considered for select patients leading to favorable outcomes. Because survival was worse in the rare cohort of patients with LN metastases, the predictors for LN metastasis identified here may aid in stratifying patients to EN versus resection.

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Title: Solid Pseudopapillary Tumor of the Pancreas: Is Enucleation Safe?
Authors: Oscar Salirrosas, MD
Eduardo A. Vega, MD
Elena Panettieri, MD
Hamed Harandi, MD
Olga Kozyreva, MD
Shree Ghanta, MD
Claudius Conrad, MD, PhD, FACS, FSSO
Publication date: 13-03-2024
Publisher: Springer International Publishing
Keywords: Pancreatoduodenostomy
Pancreatoduodenostomy
Pancreatectomy
Metastasis
Published in: Annals of Surgical Oncology / Issue 6/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-15119-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Solid Pseudopapillary Tumor of the Pancreas: Is Enucleation Safe?

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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