Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7340
Peer-review started: February 24, 2021
First decision: March 29, 2021
Revised: April 13, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 6, 2021
Processing time: 188 Days and 12.9 Hours
Pancreatic neoplasms are very rare in children and available data in this field are limited. Surgery allows the long-term survival of these patients, even if it could lead to complications such as pancreatic insufficiency. Currently there is little evidence on the onset of pancreatic failure and growth trend in children after pancreatic surgery.
We would like to increase knowledge regarding the evolution of pancreatic function after surgical resection in children with pancreatic neoplasms. Currently there is no scheduled follow-up to monitor the long-term complications of pancreatic surgery and in pediatric age it is essential to immediately diagnose the possible onset of pancreatic insufficiency to ensure adequate growth.
The aim of this study was to evaluate the long-term outcome of pancreatic function after pancreatic surgery in children, identify the incidence of endocrine and exocrine pancreatic insufficiency, fat-soluble vitamin deficiency and failure to thrive.
We retrospectively analyzed all consecutive pediatric patients diagnosed with pancreatic neoplasms who underwent pancreatic surgery in our institution between January 31, 2002 and the present. Patients were followed by a multidisciplinary team that assessed auxological parameters, clinical symptoms, laboratory and radiological tests at each follow-up visit.
Sixteen patients (12 girls and 4 boys, mean age 10.7 ± 5.3 years), were included. The most frequent surgery was pancreaticoduodenectomy (50%). Exocrine failure occurred in 4 patients (25%) within 6 mo after surgery, while endocrine failure occurred in 2 patients (12.5%) 8 and 10 years after surgery, respectively. No statistically significant differences were found in BMI z-score at diagnosis and at the last follow-up. Vitamin D was insufficient (< 30 ng/mL) in 8 of the 16 patients while vitamins A, E and clotting test were into the normal ranges in all patients.
Our study highlights that the development of exocrine and endocrine pancreatic insufficiency after pancreatic surgery is not rare; these potential complications must be adequately identified and treated, as pancreatic enzyme replacement therapy prevents malabsorption and consequent growth failure.
It is essential to identify and establish a standardized follow-up in pediatric patients, organized by a multidisciplinary team including a surgeon, oncologist, gastroenterologist, endocrinologist, radiologist and dietician.