Yield of surgery in solid pseudopapillary neoplasms of the pancreas: A case series and literature review

Table 1 Preoperative demographic data and clinical radiological characteristics

Demographic data (n = 14)	n (%)
Gender
Female/male	14 (100)/0 (0)
Mean age (yr); (range)	31.6 (20-55)
35 yr	11 (78.6)
Symptoms
Asymptomatic	12 (85.7)
Abdominal pain and vomiting	1 (7.1)
Jaundice/weight loss	1 (7.1)
Radiological characteristics
Largest injury (cm)	18
Minor injury (cm)	1.5
Average lesion size (cm); (range)	6.7 (1.5-18)
Tumor location
Head	6 (42.8)
Body/tail	8 (57.1)
Metastasis
Yes	0
No	14 (100)
Lymph node enlargement	0
Vascular invasion	2 (14.3)

Table 2 Intraoperative surgical data

Intraoperative characteristics (n = 14)	n (%)
Access way
Laproscopic	5 (38.4)
Open Laparotomy	9 (64.2)
Type of surgery
Duodenopancreatectomy	6 (42.8)
Distal pancreatectomy	8 (57.1)
Vascular resection
Yes	2 (14.2)
No	12 (85.7)
Resection of other organs
Yes	8 (57.1)
Spleen	(7)
Transverse colon	(1)
Stomach	(1)
No	6 (42.8)
Blood transfusion
Yes	2 (14.2)
No	12 (85.7)

Table 3 Postoperative characteristics, adverse events (classification and treatment), readmission, and deaths

Postoperative characteristics (n = 14)	n (%)	Clavien-Dindo
Abdominal drain	14 (100)	-
Surgical site (adverse events)	4 (28.5)	-
Surgical wound infection (PD)	1 (7.1)	II (Antibiotic)
Transient liver failure/ascites (PD)	1 (7.1)	I
Grade C pancreatic fistula (CCP); Grade B pancreatic fistula (CCP)	1 (7.1); 1 (7.1)	III (EL); II (abdominal drain)
Surgical site (adverse events outside)	1 (7.1)
Urinary infection (PD)	1 (7.1)	II (Antibiotic)
Readmission	1 (7.1)	Grade C fistula (EL)
Death up to 90 d	0

EL: Exploratory laparotomy; PD: Pancreaticoduodenectomy.

Table 4 Pathological characteristics (n = 14)

Pathological characteristics	n (%)
Free surgical margins	14 (100)
Average of resected lymph nodes	6.5
Lymph node metastasis	0
Perineural invasion	0
Angiolymphatic invasion	0
Microscopic extension of the tumor	1
Peripancreatic adipose tissue	1
Invasion of the capsule	0

Table 5 Follow-up of patients with solid pseudopapillary neoplasm of the pancreas

Year of surgery	n	Follow-up (yr)	Disease free	Conduct
1998	1	13	Yes	MD
1998	1	1	Yes	Death1
2012	4	5	Yes	MD
2013	1	5	Yes	MD
2014	2	5	Yes	MD
2015	2	5	Yes	MD
2017	1	3	Yes	SG
2018	2	2	Yes	SG

Mean follow-up: 4.7 years (range 1-13 years). Medical discharge: 10 patients; 3 patients still under follow-up, and one died a year after surgery.

¹Patient remained free of disease and died 1 year later from pneumonia, unrelated to the underlying pathology.

CD: Conduct; SG: Follow-up; MD: Medical discharge.

Table 6 Incidental and symptoms in patients with solid pseudopapillary neoplasms (literature data)

Ref.	Year	n	Study	Incidental (%)	Ap (%)	Other findings (%)
Papavramidis et al[15]	2006	718	R	15.5	46.5	Mass 34.8
Lubezky et al[16]	2017	32	R	28	48	Unspecific 24
Song et al[17]	2017	53	R	39.6	37.7	Mass 30.2
Wright et al[6]	2019	78	R	30.7	42.3	Nauseas 14.1
Lin et al[18]	2019	60	R	65	31.7	Strain 2.2
Torres et al[19]	2019	16	R	-	87.5	Mass 12.5
Liu et al[20]	2019	243	R	63.4	19	Unspecific
Farhat et al[21]	2020	10	R	20	40	Mass 40

R: Retrospective study; Ap: Abdominal pain.