Paediatrics Publications

Title

Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study

Authors

Sanjeev A. Vasudevan, Baylor College of Medicine
Tu Anh N. Ha, Baylor College of Medicine
Huirong Zhu, Baylor College of Medicine
Todd E. Heaton, Memorial Sloan-Kettering Cancer Center
Michael P. LaQuaglia, Memorial Sloan-Kettering Cancer Center
Joseph T. Murphy, Children's Medical Center Dallas
Wesley E. Barry, Keck School of Medicine of USC
Catherine Goodhue, Keck School of Medicine of USC
Eugene S. Kim, Keck School of Medicine of USC
Jennifer H. Aldrink, The Ohio State University College of Medicine
Stephanie F. Polites, University of Cincinnati
Harold J. Leraas, Duke University Medical Center
Henry E. Rice, Duke University Medical Center
Elisabeth T. Tracy, Duke University Medical Center
Timothy B. Lautz, Northwestern University
Riccardo A. Superina, Northwestern University
Andrew M. Davidoff, University of Tennessee Health Science Center
Max R. Langham, University of Tennessee Health Science Center
Andrew J. Murphy, University of Tennessee Health Science Center
Andreana Bütter, Schulich School of Medicine & DentistryFollow
Jacob Davidson, Schulich School of Medicine & Dentistry
Richard D. Glick, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
James Grijalva, Seattle Children's Hospital
Kenneth W. Gow, Seattle Children's Hospital
Peter F. Ehrlich, C.S. Mott Children's Hospital
Erika A. Newman, C.S. Mott Children's Hospital
Dave R. Lal, Medical College of Wisconsin
Marcus M. Malek, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh
Annie Le-Nguyen, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant

Document Type

Article

Publication Date

9-1-2020

Journal

Pediatric Blood and Cancer

Volume

67

Issue

9

URL with Digital Object Identifier

10.1002/pbc.28425

Abstract

Background: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). Methods: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected. Results: Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival. Conclusion: This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.

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