BAPS PaperPancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis

PurposeWhile pancreaticoduodenectomy (PD) has been extensively studied in adults, there are few data pertaining specifically to pediatric patients. We retrospectively analyzed PD-associated morbidity and mortality in pediatric patients.MethodsOur analytic cohort included all consecutive patients ≤ 18 years of age treated at our institution from 1993 to 2015 who underwent PD. Patient data (demographics, disease characteristics, surgical and adjuvant treatment, length of hospital stay, and postoperative course) were extracted from the medical records.ResultsWe identified 12 children with a median age of 9 years (7 female, 5 male). Final diagnoses were pancreatoblastoma (n = 3), solid pseudopapillary tumor (n = 3), neuroblastoma (n = 2), rhabdomyosarcoma (n = 2), and neuroendocrine carcinoma (n = 2). Four patients underwent PD for resection of recurrent disease. 75% (9/12 patients) received neoadjuvant therapy. The median operative time was approximately 7 hours with a mean blood loss of 590 cm3. The distal pancreas was invaginated into the posterior stomach (n = 3) or into the jejunum (n = 5) or was directly sewn to the jejunal mucosa (n = 4). There were no operative deaths. There were 4 patients (34%) with grade II complications, 1 with a grade IIIb complication (chest tube), and 1 with a grade IV complication (reexploration). The most common long-term morbidity was pancreas exocrine supplementation (n = 10; 83%). Five patients (42%) diagnosed with either solid pseudopapillary tumor or rhabdomyosarcoma are currently alive with a mean survival of 77.4 months.ConclusionPancreaticoduodenectomy is a feasible management strategy for pediatric pancreatic malignancies and is associated with acceptable morbidity and overall survival. Long-term outcome is mostly dependent on histology of the tumor.Level of evidenceLevel IV; retrospective study with no comparison group.