Enucleation Versus Conventional Pancreatic Resection in Pediatric Solid Pseudopapillary Neoplasm: A Retrospective Analysis of Short- and Long-Term Outcomes.
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BACKGROUND: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare low-grade malignant tumor. Conventional pancreatic resection (CP) can severely compromise pancreatic function, whereas enucleation (EN), a pancreas-preserving technique, has gradually gained traction in pediatric patients. This study aimed to compare the outcomes of enucleation (EN) and conventional pancreatic resection (CP) in pediatric patients with SPNs. METHODS: A retrospective analysis was conducted on 45 pediatric patients with pancreatic SPNs treated surgically at West China Hospital of Sichuan University between January 2013 and January 2024. Patients were divided into either the EN group (17 patients) or the CP group (28 patients). Data on demographic characteristics, preoperative imaging features, surgical data, postoperative complications, and long-term follow-up results were collected. RESULTS: Among the 45 pediatric patients, 9 were male and 36 were female, with a mean age of 13.4 ± 2.8 years. Compared with the CP group, the EN group presented a greater short-term complication rate (58.8 % vs. 32.1 %, P = 0.12), with pancreatic fistula being the predominant complication (9 vs. 5, P = 0.021), which was mainly classified as grade B POPF. During long-term follow-up, no cases of endocrine insufficiency occurred in the EN group, whereas the CP group had an incidence rate of 28.6 % (P = 0.017). The duration of follow-up was similar between the two groups (67.4 ± 40.2 vs. 80.2 ± 38.2 months, P = 0.74). EN did not increase the risk of tumor recurrence (P = 1). CONCLUSIONS: EN, as a treatment modality for pediatric pancreatic SPNs, effectively preserves endocrine and exocrine functions, reduces postoperative metabolic complications, and does not increase the risk of tumor recurrence. Despite an elevated risk of Grade B pancreatic fistula and prolonged hospitalization, these issues are manageable with conservative medical treatment.