Abstract

Background

Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors predominantly in young women. We report the largest single-center cohort study comparing resection of SPNP by laparoscopic approach (LA) and the open approach (OA).

Method

Between 2001 and 2021, 102 patients (84% women, median age: 30) underwent pancreatectomy for SPNP and were retrospectively studied. Demographic, perioperative, pathological, early and the long-term results were evaluated between patients operated by LA and those by OA.

Results

Population included 40 LA and 62 OA. There were no significant differences in demographics data between the groups. A preoperative biopsy by endoscopic ultrasound was performed in 45 patients (44%) with no difference between the groups. Pancreatoduodenectomy (PD) was less frequently performed by LA (25 vs 53%, p = 0.004) and distal pancreatectomy (DP) was more frequently performed by LA (40 vs 16%, p = 0.003). In the subgroup analysis by surgical procedure, LA-PD was associated with one mortality, less median blood loss (180 vs 200 ml, p = 0.034) and fewer harvested lymph nodes (11 vs 15, p = 0.02). LA-DP was associated with smaller median tumor size on imaging (40 vs 80mm, p = 0.048), shorter surgery (135 vs 190 min, p = 0.028), and fewer complications according to the median comprehensive complication index score (0 vs 8.7, p = 0.048). LA-Central pancreatectomy was associated with shorter surgery (160 vs 240, p = 0.037), less median blood loss (60 vs 200, p = 0.043), and less harvested lymph nodes (5 vs 2, p = 0.025). After a median follow-up of 60 months, two recurrences (2%) were observed and were unrelated to the approach.

Conclusions

The LA for SPNP appears to be safe, should be applied cautiously in case of PD for large lesion, and was not associated with recurrence.

中文翻译：

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腹腔镜和开腹胰腺切除术治疗 102 例实性假乳头状肿瘤的结果和生存率相似

摘要

背景

胰腺实性假乳头状肿瘤（SPNP）是一种罕见的肿瘤，主要发生在年轻女性中。我们报告了最大的单中心队列研究，比较了腹腔镜方法 (LA) 和开放方法 (OA) 切除 SPNP。

方法

2001年至2021年间，102名患者（84%为女性，中位年龄：30岁）因SPNP接受了胰腺切除术并进行了回顾性研究。对 LA 手术患者和 OA 手术患者的人口统计学、围手术期、病理、早期和长期结果进行评估。

结果

人口包括 40 LA 和 62 OA。各组之间的人口统计数据没有显着差异。对 45 名患者 (44%) 进行了术前超声内镜活检，各组之间没有差异。LA 进行胰十二指肠切除术 (PD) 的频率较低（25% vs 53%，p  = 0.004），而 LA 进行远端胰腺切除术 (DP) 的频率较高（40% vs 16%，p  = 0.003）。在按手术方式进行的亚组分析中，LA-PD 与 1 例死亡、中位失血量较少（180 毫升 vs 200 毫升， p  = 0.034）和淋巴结获取较少（11 比 15，p = 0.02）相关 。LA-DP 与影像学上较小的中位肿瘤尺寸（40 vs 80mm， p  = 0.048）、较短的手术时间（135 vs 190 分钟，p = 0.028）以及根据中位综合并发症指数评分的较少并发症相关 （0 vs 8.7） ，p  = 0.048）。LA-中央胰腺切除术与手术时间较短（160 vs 240， p  = 0.037）、中位失血量较少（60 vs 200，p  = 0.043）和淋巴结切除较少（5 vs 2，p  = 0.025）相关。中位随访 60 个月后，观察到两次复发 (2%)，且与该方法无关。

结论

SPNP 的 LA 似乎是安全的，在大病灶发生 PD 的情况下应谨慎应用，并且与复发无关。