Sanjeev A Vasudevan1, Tu-Anh N Ha1, Huirong Zhu1, Todd E Heaton2, Michael P LaQuaglia2, Joseph T Murphy3, Wesley E Barry4, Catherine Goodhue4, Eugene S Kim4, Jennifer H Aldrink5, Stephanie F Polites6, Harold J Leraas7, Henry E Rice7, Elisabeth T Tracy7, Timothy B Lautz8, Riccardo A Superina8, Andrew M Davidoff9, Max R Langham9, Andrew J Murphy9, Andreana Bütter10, Jacob Davidson10, Richard D Glick11, James Grijalva12, Kenneth W Gow12, Peter F Ehrlich13, Erika A Newman13, Dave R Lal14, Marcus M Malek15, Annie Le-Nguyen16, Nelson Piché16, David H Rothstein17, Scott S Short18, Rebecka Meyers18, Roshni Dasgupta6. 1. Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas. 2. Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York. 3. Division of Pediatric Surgery, UT Southwestern Medical School, Children's Medical Center, Dallas, Texas. 4. Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California. 5. Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio. 6. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. 7. Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina. 8. Division of Pediatric Surgery, Division of Transplant Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois. 9. Department of Surgery, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee. 10. Division of Pediatric Surgery, Children's Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 11. Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Queens, New York. 12. Division of Pediatric Surgery, Seattle Children's Hospital, Seattle, Washington. 13. Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, Michigan. 14. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 15. Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 16. Division of Pediatric Surgery, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada. 17. Department of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York. 18. Division of Pediatric Surgery, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah.
Abstract
BACKGROUND: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). METHODS: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected. RESULTS: Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival. CONCLUSION: This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.
BACKGROUND: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). METHODS: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected. RESULTS: Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival. CONCLUSION: This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.
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