R. E. Jones3, J. A. Zagory1,2, J. T. Murphy1,2 1University Of Texas Southwestern Medical Center,Pediatric Surgery,Dallas, TX, USA 2Children’s Medical Center,Pediatric Surgery,Dallas, Tx, USA 3University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA
Introduction:
Pediatric pancreatic resection is rare. Previous studies examining outcomes are limited by small size. We reviewed our experience with pediatric pancreatic resections to examine the clinical indications and outcomes in children. We hypothesized that the presented operations are effective and safe in this special population.
Methods:
After IRB approval, we retrospectively reviewed all patients <18 years old who underwent pancreatic resection (distal, central, total pancreatectomy; pancreaticoduodenectomy [Whipple]; lateral pancreaticojejunostomy [Puestow]) between January 2005 and December 2018. We collected demographics, surgical indication, operative procedure, complications, unexpected hospital visits, and mortality in order to determine the clinical characteristics of children undergoing pancreatic resection.
Results:
A total of 44 patients underwent 45 pancreatic resections during the study period. Table 1 summarizes patient data by type of pancreas resection, including indications for surgery and complication rate per procedure. There were 27 distal pancreatectomies, 1 central and 1 total pancreatectomy, 9 Whipple, and 7 Peustow procedures performed. Pancreatic mass was the most common indication for resection (n=27, 60%), followed by traumatic injury (n=10, 22%) and chronic pancreatitis (n=7, 16%). The average length of procedure was 4.5 hours (range 1.9 -10.5) with an estimated blood loss of 208 (range 1-1500 mL). On final pathology, the most common finding was solid pseudopapillary tumor (SPT, n=16, 36%), followed by traumatic injury (n=10, 22%). Postoperatively, 11 patients (24%) required temporary total parental nutrition. Twelve patients (27%) were admitted to ICU postoperatively, with an average of 1 ICU days per patient (range 0-13 days). The overall complication rate was 0.62 (range 0-3) complications per procedure, including 4 pancreatic leaks. The overall unexpected hospital visit rate (ED evaluations and readmissions) was 0.78 (range 0-6) visits per patient. There were no mortalities in this series.
Conclusion:
While pancreatic resection is a relatively rare procedure in children, our data demonstrate clear indications in this population with a relatively low associated complication rate. This retrospective series highlights the safety and usefulness of pancreas resection in children.
