S. A. Mansfield1, J. P. Walker2, J. H. Aldrink3 1Ohio State University,Department Of General Surgery,Columbus, OH, USA 2Ohio State University,Division Of Gastroenterology, Hepatology And Nutrition,Columbus, OH, USA 3Nationwide Children’s Hospital,Division Of Pediatric Surgery,Columbus, OH, USA
Introduction:
Pancreatic malignancy and chronic pancreatitis are rare in the pediatric, adolescent, and young adult (AYA) population, making pancreas resections an infrequent procedure in this demographic. Only case reports and small case series exist in the literature describing surgical outcomes and complications in this population. The aim of this study is to review the surgical complications and outcomes of pediatric and AYA patients undergoing pancreaticoduodenectomy at our institution.
Methods:
All pediatric, adolescent, and young adult patients (≤30 years) undergoing pacreaticoduodenectomy over a 15-year period (1998-2013) were identified for inclusion in this single-center, observational cohort study. Retrospective chart review was performed to identify pertinent preoperative, perioperative, and postoperative data, including indications for procedure, duration of hospital stay, pathologic data, 30-day mortality, complications, and re-operation data. Overall survival and disease-free survival was calculated using Kaplan-Meier curves.
Results:
Twenty-one patients with a median age of 25 years (range 11-30 years) underwent pancreaticoduodenectomy during the study period and comprised the cohort. Indications for surgery included chronic pancreatitis in 3 and mass/malignancy in 18. The most common post-operative histologic diagnoses were chronic pancreatitis (5, 23.8%), solid pseudopapillary neoplasm (5, 23.8%), and adenocarcinoma (4, 19.0%). For tumor resections, all surgical margins were negative. Six patients required reoperation, with a median time to reoperation of 26 months (range 4.4-136.1). Three reoperations were required in patients with chronic pancreatitis, all due to recurrent or continued pain. Other indications for re-operation included stricture of hepaticojejunostomy (n=1), primary choledocholithiasis (n=1) and upper gastrointestinal bleeding (n=1). The most common postoperative complication was intraabdominal abscess (3, 14.3%). Pancreatic leak occurred in only one patient. Thirty-day mortality was 0% for all patients. There were no recurrences or disease-related deaths in patients with solid pseudopapillary neoplasm. Patients with adenocarcinoma had a median survival of 15.6 (range 9-142) months.
Conclusion:
This is the largest series of pancreaticoduodenectomy procedures reported in the pediatric and AYA population. As in adults, surgical resection remains the mainstay of treatment for neoplasms of the pancreas and complicated chronic pancreatitis for the pediatric and AYA groups. Given how rare these pancreatic conditions are in this age group, cohort studies such as this may help improve therapies for this unique patient population.