Surgical treatment of patients with solid-pseudopapillary neoplasm of pancreas: A single center experience in 51 cases / 第二军医大学学报

ABSTRACT

Objective To summarize the clinicopathologic features of solid-pseudopapillary neoplasm of pancreas (SPNP), and to explore its diagnosis and surgical strategy. Methods The clinical data of 51 patients with SPNP were collected from Department of Pancreas Surgery, Changhai Hospital between September 2008 and June 2012, and the clinical characteristics and surgical strategy were retrospectively analyzed. The patients were divided into solid tumor and cystic tumor group according to tumor texture, and a case-control study was designed to analyze the correlation between tumor texture and invasive pathological characteristics. Results Forty-five of the 51 patients were females and 6 were males (7. 51), with a mean age of (33. 5±10. 8) years old at diagnosis, ranging from 8 to 53 years. Twenty-two (43. 1%) cases with no symptom were detected by physical examination, 23 cases were detected by epigastric pain (16, 31. 4%) or discomfort (7, 13. 7%), 3 (5. 9%) patients had a palpable abdominal mass and another 3 (5. 9%) had nausea and vomiting. The average diameter of the neoplasms was (6. 3±5. 8) cm (ranged from 1 to 37. 8 cm). The neoplasms were mainly located at the body and tail of the pancreas (25, 49. 0%), followed by the neck (14, 27. 5%) and head (12, 23. 5%) of the pancreas. The patients underwent surgical resection via pancreaticoduodenectomy (n=5), pylorus-preserving pancreaticoduodenectomy (n=5), segmental pancreatectomy (n=7), distal pancreatectomy (n=21), spleen-preserving distal pancreatectomy (n=7) and local resection of pancreatic neoplasms (n=6). Only one patient had tumor marker (CA19-9) elevated slightly, and others had normal level (CA19-9, CEA, CA125). Pathologic results showed that 15 of the 51 patients had invasive pathological characteristics. The results of case-control study indicated that solid tumor was significantly correlated with pancreas parenchymal invasion (P<0. 01), cellular pleomorphism (P<0. 01) and perineural invasion (P<0. 05). Six of the 51 patients were lost to follow-up, and the follow-up time of other patients lasted for 26-74 months, during which no evidence of recurrence or metastasis was noted. Conclusion SPNP is a rare low-grade malignant tumor; surgical resection is currently the optimal and effective treatment for SPNP, and conservative operation procedure is better than the relatively aggressive ones. This study also suggests that solid tumor is associated with some malignant pathological characteristics, such as pancreas parenchymal invasion, cellular pleomorphism and perineural invasion.