Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis Journal Article

Authors: Lindholm, E. B.; Alkattan, A. K.; Abramson, S. J.; Price, A. P.; Heaton, T. E.; Balachandran, V. P.; La Quaglia, M. P.
Article Title: Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis
Abstract: Purpose While pancreaticoduodenectomy (PD) has been extensively studied in adults, there are few data pertaining specifically to pediatric patients. We retrospectively analyzed PD-associated morbidity and mortality in pediatric patients. Methods Our analytic cohort included all consecutive patients ≤ 18 years of age treated at our institution from 1993 to 2015 who underwent PD. Patient data (demographics, disease characteristics, surgical and adjuvant treatment, length of hospital stay, and postoperative course) were extracted from the medical records. Results We identified 12 children with a median age of 9 years (7 female, 5 male). Final diagnoses were pancreatoblastoma (n = 3), solid pseudopapillary tumor (n = 3), neuroblastoma (n = 2), rhabdomyosarcoma (n = 2), and neuroendocrine carcinoma (n = 2). Four patients underwent PD for resection of recurrent disease. 75% (9/12 patients) received neoadjuvant therapy. The median operative time was approximately 7 hours with a mean blood loss of 590 cm3. The distal pancreas was invaginated into the posterior stomach (n = 3) or into the jejunum (n = 5) or was directly sewn to the jejunal mucosa (n = 4). There were no operative deaths. There were 4 patients (34%) with grade II complications, 1 with a grade IIIb complication (chest tube), and 1 with a grade IV complication (reexploration). The most common long-term morbidity was pancreas exocrine supplementation (n = 10; 83%). Five patients (42%) diagnosed with either solid pseudopapillary tumor or rhabdomyosarcoma are currently alive with a mean survival of 77.4 months. Conclusion Pancreaticoduodenectomy is a feasible management strategy for pediatric pancreatic malignancies and is associated with acceptable morbidity and overall survival. Long-term outcome is mostly dependent on histology of the tumor. Level of evidence Level IV; retrospective study with no comparison group. © 2017 Elsevier Inc.
Keywords: pancreaticoduodenectomy; solid pseudopapillary tumor; pancreatic tumor; whipple procedure; pancreatoblastoma
Journal Title: Journal of Pediatric Surgery
Volume: 52
Issue: 2
ISSN: 0022-3468
Publisher: W.B. Saunders Co-Elsevier Inc.  
Date Published: 2017-02-01
Start Page: 299
End Page: 303
Language: English
DOI: 10.1016/j.jpedsurg.2016.11.025
PROVIDER: scopus
PMCID: PMC5253309
PUBMED: 27894759
Notes: Article -- Export Date: 2 February 2017 -- Source: Scopus
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