Clinical value analysis of simple resection of pancreatic solid pseudopapillary tumor

doi:10.16139/j.1007-9610.2024.01.05

Abstract

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

CLC Number:

R735.9

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.

Figures/Tables 5

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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