LAPAROSCOPIC PANCREATIC RESECTIONS FOR SOLID PSEUDOPAPILLARY TUMOR IN CHILDREN
Y Sokolov, S Stonogin, О Povarnin, S Yurkov, A Leonidov
Russian Medical Academy of Postgraduate Education, Tushin's Children's Hospital, Moscow, Russia
Aim: Solid pseudopapillary tumor (SPT) of the pancreas or Frantz tumor is a very rare clinic entity, representing 1% to 2% of all primary exocrine pancreatic tumors with a relatively low grade of malignant potential, occurring predominantly in young female patients. The aim of this study is to investigate the effectiveness of laparoscopic pancreatic resections for SPT in children.
Methods: Two 13-year-old girls suffered from recurrent episodes of abdominal pain. Ultrasound and CT revealed 6.5x5-cm well-circumscribed heterogeneous mass arising from the neck of the pancreas in one and 6x5.5-cm solid homogeneous tumor with little cystic areas in the pancreatic tail in another. Both patients underwent laparoscopic procedures using 10 mm 30 degree camera, two 5 mm and one 3 mm ports. In the first case after division of gastrocolic ligament the tunnel was created beneath the pancreatic neck, separating the pancreatic parenchyma from the superior mesenteric vein and portal vein confluence. The pancreas was then divided to the right of the lesion by mono- and bipolar electrocautery. The stump of the proximal pancreas was oversewn with continuous 5-0 PDS. Then the body of the pancreas was divided to the left of the lesion. Two-layer anastomosis between the distal pancreatic body and the posterior gastric wall was accomplished. The inner layer was constructed using intracorporeal running suture with 5-0 Vicryl along the circumference of the pancreas. The outer layer was composed of intracorporeal interrupted sutures of 5-0 PDS to invaginate the cut of the pancreas remnant. In the second case the inferior border of the gland was dissected and the tail with the mass detached from retroperitoneum and splenic vessels. The distal pancreatectomy was achieved by transection with bipolar electrocautery. The pancreatic stump was oversewn with continuous 5-0 PDS. In both cases the resected specimens were removed in the endoscopic bags through enlarged umbilical port site. The single closed-suction drains were placed in the operative field.
Results: The both procedures were completed laparoscopically. The mean duration time was 240 min. and 150 min., respectively. The suctions drains were removed on 7th postoperative days. Realimantation was started on the day 5. Postoperative course was uneventful. CT-scans control at 6 months and 2 years were normal. Histopathologic examinations demonstrated SPT of the pan-creas in both cases.
Conclusion: As experience with minimally invasive technique continues to grow, laparoscopic pancreatic resections would see safe and feasible in children with SPT. Laparoscopic central pancreatectomy with distal pancreaticogastrostomy can be used treat select tumors of the pancreas. For tumors located in the pancreatic body or tail laporoscopic spleen-preserving dis pancreatectomy may well become the approach of choice.
10-th ANN. Congress of the European Paediatric Surgeons Association, 56th ANN. Congress of the British Association of Paediatric Surgeons, EUPSA + BAPS 17-th-20th of june 2009, Graz - Austria, book of abstracts, pp. 129-130.