单纯切除胰腺实性假乳头状瘤的临床价值分析

doi:10.16139/j.1007-9610.2024.01.05

摘要/Abstract

摘要：

目的：探讨单纯切除治疗胰腺实性假乳头状瘤（SPT）的临床应用价值。方法：回顾性分析复旦大学附属华山医院胰腺囊性肿瘤数据库中2015年1月至2022年12月接受单纯切除与常规胰腺切除术的SPT病人的临床及随访资料。共纳入87例SPT病人，其中单纯切除组14例，常规切除组73例。平均年龄(36.2±11.7)岁，女性占87.4%。结果：术前影像学诊断准确率可达88.5%。单纯切除在手术时间上相对常规切除具有显著优势[（138.3±56.4） min比(241.2±89.2） min，P<0.05]。单纯切除组常见术后并发症发生方面不劣于常规切除组。87例中仅3例常规切除组病人术后出现复发转移，复发病人目前仍均生存。单纯切除组相对常规切除组在术后胰腺内、外分泌功能不全及生活质量方面差异无统计学意义。结论：单纯切除治疗SPT具有合理性和可行性，但实际临床工作中的风险性仍不容忽视。因此，选择性地对SPT行单纯切除具有一定的临床应用价值。

关键词: 胰腺实性假乳头状瘤, 胰腺肿瘤单纯切除术, 术后并发症, 临床价值分析

Abstract:

Objective To explore the clinical application value of simple resection in the treatment of pancreatic solid pseudopapillary tumor(SPT). Methods Retrospective analysis of clinical and follow-up data of pancreatic SPT patients who underwent simple pancreatectomy and conventional pancreatectomy from January 2015 to December 2022 in the pancreatic cystic tumor database of Huashan Hospital, Fudan University. A total of 87 patients with pancreatic SPT, including 14 cases underwent simple resection and 73 cases underwent conventional resection, were included. The average age was (36.2±11.7) years old, and females accounting for 87.4%. Results The accuracy of preoperative imaging diagnosis reached 88.5%. Simple resection had a significant advantage over conventional resection in terms of surgical time [(138.3±56.4) min vs. (241.2±89.2) min, P<0.05]. Simple resection was not inferior to conventional resection in terms of common postoperative complications. Out of 87 cases, only 3 patients in conventional resection group experienced postoperative recurrence and metastasis, and all recurrent patients were still alive. There was no statistically significant difference in postoperative pancreatic endocrine and exocrine dysfunction, and quality of life between simple resection group and conventional resection group. Conclusions Simple resection of pancreatic SPT is reasonable and feasible, but the risks in actual clinical work cannot be ignored. Therefore, selective simple resection of SPT has certain clinical application value.

Key words: Solid pseudopapillary tumor of the pancreas, Simple resection, Postoperative complication, Clinical value analysis

中图分类号:

R735.9

郭宇杰, 唐颖, 顾季春, 杨峰, 刘华晔, 金忱, 傅德良, 李骥. 单纯切除胰腺实性假乳头状瘤的临床价值分析[J]. 外科理论与实践, 2024, 29(01): 27-33.

GUO Yujie, TANG Ying, GU Jichun, YANG Feng, LIU Huaye, JIN Chen, FU Deliang, Li Ji. Clinical value analysis of simple resection of pancreatic solid pseudopapillary tumor[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 27-33.

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参考文献 39

[1]	CHO Y J, NAMGOONG J M, KIM D Y, et al. Suggested indications for enucleation of solid pseudopapillary neoplasms in pediatric patients[J]. Front Pediatr, 2019,7:125.
[2]	ERIC D, MILOSAVLJEVIC V, GONZALEZ-URQUIJO M, et al. Laparoscopic enucleation of Frantz's tumor of the pancreas: case report and literature review[J]. Ann Med Surg(Lond), 2021,64:102221.
[3]	WANG X, CHEN Y H, TAN C L, et al. Enucleation of pancreatic solid pseudopapillary neoplasm: short-term and long-term outcomes from a 7-year large single-center experience[J]. Eur J Surg Oncol, 2018, 44(5):644-650. doi: S0748-7983(18)30122-7 pmid: 29525465
[4]	ROMICS L J R, OLÁH A, BELÁGYI T, et al. Solid pseudopapillary neoplasm of the pancreas—proposed algorithms for diagnosis and surgical treatment[J]. Langenbecks Arch Surg, 2010, 395(6):747-755.
[5]	HE C, ZHU L, WANG X, et al. Presumed radiological dia-gnosis of solid pseudopapillary tumors: do we really know what we are watching?[J]. Pancreatology, 2023, 23(1):120-128.
[6]	SILANO F, DE MELO AMARAL R B, SANTANA R C, et al. Yield of surgery in solid pseudopapillary neoplasms of the pancreas: a case series and literature review[J]. World J Gastrointest Oncol, 2021, 13(6):589-599.
[7]	LUBEZKY N, PAPOULAS M, LESSING Y, et al. Solid pseudopapillary neoplasm of the pancreas: management and long-term outcome[J]. Eur J Surg Oncol, 2017, 43(6):1056-1060. doi: S0748-7983(17)30346-3 pmid: 28238521
[8]	SUN G, FANG K, FU X, et al. Solid pseudopapillary neoplasm of the pancreas: a multi-institution study of 118 cases[J]. Pancreas, 2023, 52(2):e121-e126.
[9]	YOU L, YANG F, FU D L. Prediction of malignancy and adverse outcome of solid pseudopapillary tumor of the pancreas[J]. World J Gastrointest Oncol, 2018, 10(7):184-193.
[10]	KANG C M, CHOI S H, KIM S C, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea[J]. Ann Surg, 2014, 260(2):348-355. doi: 10.1097/SLA.0000000000000583 pmid: 24743622
[11]	YEPURI N, NAOUS R, MEIER A H, et al. A systematic review and meta-analysis of predictors of recurrence in patients with solid pseudopapillary tumors of the pancreas[J]. HPB (Oxford), 2020, 22(1):12-19.
[12]	MACHADO M C, MACHADO M A, BACCHELLA T, et al. Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients[J]. Surgery, 2008, 143(1):29-34.
[13]	GAO Y, GUO F, LU Z, et al. Perioperative safety and prognosis following parenchyma-preserving surgery for solid pseudopapillary neoplasm of the pancreas[J]. World J Surg Oncol, 2023, 21(1):119. doi: 10.1186/s12957-023-03003-y pmid: 37004027
[14]	BEGER H G. Benign tumors of the pancreas-radical surgery versus parenchyma-sparing local resection-the challenge facing surgeons[J]. J Gastrointest Surg, 2018, 22(3):562-566.
[15]	KUSAKABE J, ANDERSON B, LIU J, et al. Long-term endocrine and exocrine insufficiency after pancreatectomy[J]. J Gastrointest Surg, 2019, 23(8):1604-1613. doi: 10.1007/s11605-018-04084-x pmid: 30671791
[16]	FAITOT F, GAUJOUX S, BARBIER L, et al. Reappraisal of pancreatic enucleations: a single-center experience of 126 procedures[J]. Surgery, 2015, 158(1):201-210.
[17]	SONG K B, KIM S C, HWANG D W, et al. Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients[J]. Surgery, 2015, 158(5):1203-1210.
[18]	WANG X, TAN C L, ZHANG H, et al. Short-term outcomes and risk factors for pancreatic fistula after pancrea-tic enucleation: a single-center experience of 142 patients[J]. J Surg Oncol, 2018, 117(2):182-190.
[19]	BASSI C, MARCHEGIANI G, DERVENIS C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after[J]. Surgery, 2017, 161(3):584-591.
[20]	LA ROSA S, BONGIOVANNI M. Pancreatic solid pseudopapillary neoplasm: key pathologic and genetic features[J]. Arch Pathol Lab Med, 2020, 144(7):829-837.
[21]	彭承宏, 郝纯毅, 戴梦华, 等. 胰腺囊性疾病诊治指南(2015版)[J]. 临床肝胆病杂志, 2015, 31(9):1375-1378.
	PENG C H, HAO C Y, DAI M H, et al. Guidelines for the management of pancreatic cystic lesions(2015)[J]. J Clin Hepatol, 2015, 31(9):1375-1378.
[22]	GORDON-DSEAGU V L, DEVESA S S, GOGGINS M, et al. Pancreatic cancer incidence trends: evidence from the Surveillance, Epidemiology and End Results (SEER) population-based data[J]. Int J Epidemiol, 2018, 47(2):427-439.
[23]	GUO N, ZHOU Q B, CHEN R F, et al. Diagnosis and surgical treatment of solid pseudopapillary neoplasm of the pancreas: analysis of 24 cases[J]. Can J Surg, 2011, 54(6):368-374. doi: 10.1503/cjs.011810 pmid: 21939604
[24]	LIU Q, DAI M, GUO J, et al. Long-term survival, quality of life, and molecular features of the patients with solid pseudopapillary neoplasm of the pancreas: a retrospective study of 454 cases[J]. Ann Surg, 2023, 278(6):1009-1017. doi: 10.1097/SLA.0000000000005842 pmid: 37036095
[25]	林贤超, 林荣贵, 陆逢春, 等. 微创手术治疗胰腺实性假乳头状瘤临床疗效分析(附单中心89例报告)[J]. 中国实用外科杂志, 2023, 43(7):777-781.
	LIN X C, LIN R G, LU F C, et al. Clinical efficacy of minimally invasive surgery for solid pseudopapillary neoplasm of pancreas: a report of 89 cases in a single center[J]. Chin J Pract Surg, 2023, 43(7):777-781.
[26]	LANKE G, ALI F S, LEE J H. Clinical update on the management of pseudopapillary tumor of pancreas[J]. World J Gastrointest Endosc, 2018, 10(9):145-155. doi: 10.4253/wjge.v10.i9.145 pmid: 30283597
[27]	BUTTE J M, BRENNAN M F, GÖNEN M, et al. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center[J]. J Gastrointest Surg, 2011, 15(2):350-357. doi: 10.1007/s11605-010-1337-1 pmid: 20824369
[28]	YAO J, SONG H. A review of clinicopathological characteristics and treatment of solid pseudopapillary tumor of the pancreas with 2450 cases in Chinese population[J]. Biomed Res Int, 2020,2020:2829647.
[29]	DENIZ K, ARIKAN T B, BAŞKOL M, et al. Solid pseudopapillary neoplasm of the pancreas[J]. J Gastrointest Surg, 2021, 25(1):322-324.
[30]	TJADEN C, HASSENPFLUG M, HINZ U, et al. Outcome and prognosis after pancreatectomy in patients with solid pseudopapillary neoplasms[J]. Pancreatology, 2019, 19(5):699-709. doi: S1424-3903(19)30609-X pmid: 31227367
[31]	黄玉芳, 杨伟川, 胡振洲, 等. 胰腺实性假乳头状瘤的CT及MRI表现[J]. 现代医用影像学, 2023, 32(5):860-863.
	HUANG Y F, YANG W C, HU Z Z. CT and MRI manifestations of solid pseudopapillary tumour of the pancreas[J]. Mod Med Imageology, 2023, 32(5):860-863.
[32]	LIU M, LIU J, HU Q, et al. Management of solid pseudopapillary neoplasms of pancreas: a single center experience of 243 consecutive patients[J]. Pancreatology, 2019, 19(5):681-685. doi: S1424-3903(19)30616-7 pmid: 31281058
[33]	FALCONI M, MANTOVANI W, CRIPPA S, et al. Pancrea-tic insufficiency after different resections for benign tumours[J]. Br J Surg, 2008, 95(1):85-91.
[34]	TREGLIA G, CAPORALE N, RUFINI V, et al. Usefulness of ¹⁸F-FDG PET/CT in an unusual case of solid-pseudopapillary pancreatic tumor in childhood with aggressive behavior[J]. Clin Nucl Med, 2013, 38(1):e35-e37.
[35]	LAW J K, STOITA A, WEVER W, et al. Endoscopic ultrasound-guided fine needle aspiration improves the pre-operative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas: an international multicenter case series (with video)[J]. Surg Endosc, 2014, 28(9):2592-2598. doi: 10.1007/s00464-014-3508-8 pmid: 24718662
[36]	HOSOKAWA I, SHIMIZU H, OHTSUKA M, et al. Pre-operative diagnosis and surgical management for solid pseudopapillary neoplasm of the pancreas[J]. J Hepatobiliary Pancreat Sci, 2014, 21(8):573-578.
[37]	European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms[J]. Gut, 2018, 67(5):789-804. doi: 10.1136/gutjnl-2018-316027 pmid: 29574408
[38]	HÜTTNER F J, KOESSLER-EBS J, HACKERT T, et al. Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms[J]. Br J Surg, 2015, 102(9):1026-1036.
[39]	BRIENT C, REGENET N, SULPICE L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation[J]. J Gastrointest Surg, 2012, 16(10):1883-1887. pmid: 22872510

Item	SR （n=14）	non-SR （n=73）	t/χ² value	P value
Gender			0.040	0.840
Female	12（85.7）	64（87.7）
Male	2（14.3）	9（12.3）
Age(years)	36.5±11.8	34.8±11.8	0.602	0.549
Tumor diameter（cm）	4.8±2.8	3.4±1.3	1.851	0.068
Tumor location[n(%)]			8.790	0.003
Head and uncinate process	12（85.7）	31（42.5）
Body and tail	2（14.3）	42（57.5）
Symptom[n(%)]
Asymptomatic	9（64.3）	46（63.1）	0.008	0.927
Abdominal pain	4（28.6）	22（30.1）
Abdominal distension	1（7.1）	5（6.8）
Radiographic appearance[n(%)]
Cyst	2（14.3）	3（4.1）	2.246	0.134
Solid	7（50.0）	25（34.2）	1.254	0.263
Solid and cyst	5（35.7）	45（60.8）	3.231	0.072
Calcifications	2（14.3）	19（26.0）	0.884	0.347
Preoperative examination[n(%)]
CT	14（100.0）	73（100.0）
MRI	4（28.6）	10（13.7）	1.924	0.165
EUS/EUS-FNA	2(14.3)	7(9.6)	0.279	0.597
PET-CT	2(14.3)	2(2.7)	3.570	0.058
Preoperative diagnose[n(%)]			2.992	0.084
SPT	10(71.4)	67(91.6)
Fuzzy diagnoses	0	3(4.2)
PNET	2(14.3)	3(4.2)
Pseudocyst	1(7.1)	0
PDAC	1(7.1)	0
Tumor marker[n(%)]
Elevated CA19-9	0	1(1.4)	0.194	0.660
Elevated CEA	0	1(1.4)	0.194	0.660
Elevated CA125	0	1(1.4)	0.194	0.660

Item	SR （n=14）	non-SR （n=73）	t/χ² value	P value
Operating time (min)	138.3±56.4	241.2±89.2	4.146	0.001
Intraoperative blood loss （mL）	75.0±76.8	221.3±309.1	1.754	0.083
Laparoscope procedure	0	28(38.4)	7.918	0.005
Overall morbidity			0.596	0.440
Clavien-Dindo Ⅰ-Ⅱ	14(100)	70(95.9)
Clavien-Dindo Ⅲ-Ⅴ	0	3(4.1)
POPF
No POPF	0	2(2.7)	0.392	0.531
Biochemical leakage	12(85.7)	53(72.6)	1.069	0.301
Grade B	2(14.3)	16(21.9)	0.417	0.518
Grade C	0	2(2.7)	0.392	0.531
CR-POPF	2（14.3）	18（24.7）	0.909	0.398
Postoperative hemorrhage	0	2（2.7）	0.392	0.531
Postoperative intra- abdominal infection	0	4（5.4）	0.804	0.370
DGE	0	1（1.4）	0.194	0.660
Hospital stay(d)	11.7±2.4	12.9±3.5	1.264	0.210
Hospitalization expenses (yuan)	64 650.8±10 886.6	68 955.0±14 075.7	1.082	0.282
Reoperation	0	2（2.7）	0.392	0.531

Item	SR group （n=14）	non-SR group （n=73）	t/χ² value	P value
Tumor recurrence	0	3（4.2）	0.595	0.440
Local recurrence	0	0
Metastasis	0	3（4.2）
PFS(m)	38.1±21.2	55.5±23.1	2.599	0.011
OS(m)	38.1±21.2	56.5±23.1	2.757	0.007
Pancreatic endocrine insufficiency
New-onset diabetes	0	4(5.4)	0.804	0.370
Worsen diabetes	1（7.1）	1（1.4）	1.743	0.187
Pancreatic exocrine insufficiency
Diarrhea/Steatorrhea	0	5（6.8）	1.017	0.313
Weight loss	0	2（2.7）	0.392	0.531
Pancreatic enzymes replacement treatment	1（7.1）	24（32.9）	3.799	0.051
Physical health influence	1（7.1)	16(21.2)	1.631	0.202
Mental health influence	1（7.1）	12（16.4）	0.799	0.371
Social function influence	1(7.1)	5(6.8)	0.002	0.968