Multidisciplinary approach to surgical disorders of the pancreas in children
Authors:
J. Šnajdauf 1; M. Rygl 1; O. Petrů 1; B. Frýbová 1; J. Náhlovský 1; V. Mixa 2; R. Keil 3; J. Bronský 4; M. Kynčl 5; R. Kodet 6
Authors‘ workplace:
Klinika dětské chirurgie, 2. LF Univerzity Karlovy a FN Motol, Praha
1; Klinika anesteziologie a resuscitace a intenzivní medicíny, 2. LF Univerzity Karlovy a FN Motol, Praha
2; Interní klinika, 2. LF Univerzity Karlovy a FN Motol, Praha
3; Pediatrická klinika, 2. LF Univerzity Karlovy a FN Motol, Praha
4; Klinika zobrazovacích metod, 2. LF Univerzity Karlovy a FN Motol, Praha
5; Ústav patologie a molekulární medicíny, 2. LF Univerzity Karlovy a FN Motol, Praha
6
Published in:
Rozhl. Chir., 2018, roč. 97, č. 3, s. 109-116.
Category:
Original articles
Overview
Introduction:
Surgical diseases of the pancreas in children are not common and may be associated with significant morbidity and potential mortality. A multidisciplinary approach is essential for correct diagnosis, surgical strategy and postoperative as well as follow-up care.
Method:
Retrospective analysis of patients operated on due to a pathological lesion of the pancreas focused on diagnostics, operating procedures, postoperative complications, and long-term results.
Between 1991 and 2016, eighty-nine children were treated in our department for a pathologic lesion of the pancreas. 39 of them were boys and 50 were girls.
Results:
Mean age of the patients was 9.3 years (1 month–18.4 years). Patients were followed from the operation to the age of 19, after which they were referred for follow-up to adult specialists. The indications for surgery were trauma in 34 children, solid pseudopapillary tumor in 23 children, biopsy in 10, hyperinsulinism in 8, chronic pancreatitis in 4, pancreatic cyst in 3, insulinoma in 3, carcinoma in 2, and serous cystadenoma and pancreas divisum in one patient. The most frequent procedures performed on the pancreas were distal pancreatectomy in 35 cases, the duodenum-preserving pancreatic head resection in 23 cases, pseudocystogastroanastomosis in 11 cases, 90−95% pancreatic resection in 5 cases, Whipple operation in two cases, Puestow procedure in one case, tumor enucleation in one case, and tumor biopsy for cancer in one case. In 5 patients after major pancreatic injury, ERCP and papillotomy with insertion of a stent into the pancreatic duct was performed. 3 patients died, one after a polytrauma with severe pancreatic injury and two patients with pancreatic cancer.
Conclusion:
Pancreatic surgery in children is not a common operation, and individual as well as institutional experience remains limited. After more than 20 years of experience with pancreatic surgery, we believe that close cooperation with surgeons, pediatric gastroenterologists, radiologists, anesthesiologists, intensivist, pathologists and ERCP specialists is necessary for successful diagnosis and treatment of pancreatic disease in children.
Key words:
pancreas − pancreatic surgery in children − duodenum preserving head resection of the pancreas
Sources
1. Stringer MD, Davison SM, McClean P, et al. Multidisciplinary management of surgical disorders of the pancreas in childhood. JPGN 2005;40:363−7.
2. van den Akker, Angelini P, Taylor G, et al. Malignant pancreatic tumors in children: a single – institution series. J Pediatr Surg 2012;47:681−7.
3. Perez EA, Gutierrez JC, Leonidas G, et al. Malignant pancreatic tumors - incidence and outcome in 58 pediatric patients. J Pediatr Surg 2009;44:197–203.
4. Shukri N, Wasa M, Hasegawa T, et al. Diagnostic significance of pancreas divisum in early life. Eur J Pediatr Surg 2000;10:12−16.
5. Šnajdauf J, Petrů O, Náhlovský J, et al. Pancreas divisum in children and duodenum - preserving resection of the pancreatic head. V tisku 2017. Available from:http://dx.doi.org/10.1055/s-0037-1599838.ISSN 0939-7248.
6. Boulanger SC, Borowitz DS, Fisher JF, et al. Congenital pancreatic cysts in children. J Pediatr Surg 2003;38:1080−2.
7. Doher P, Diab N, Melki I, et al. Congenital cyst of the pancreas – antenatal diagnosis. Eur J Pediatr Surg 1996;6:180−2.
8. Peranteau WH, Bathaii SM, Pawel B, et al. Multiple ectopic lesions of focal islet adenomatosis identified by positron emission tomography scan in an infant with congenital hyperinsulinism. J Pediatr Surg 2007;42:188−92.
9. Pierro A, Nah SA. Surgical management of congenital hyperinsulinism of infancy. Seminars in Pediatric Surgery 2011;20:50−53.
10. Laje P, Stanley ChS, Palladino AA, et al. Pancreatic head resection and Roux-en-Y pancreaticojejunostomy for the treatment of the focal form of congenital hyperinsulinism. J Pediatr Surg 2012;47:130–5.
11. Meier DE, Coln CD, Hicks BA, at al. Early operation in children with pancreas transection. J Pediatr Surg 2001; 36: 341−4.
12. Sutherland I, Ledder O, Crameri J, et al. Pancreatic trauma in children. Pediatr Surg Int 2010;26:1201–6.
13. Okamoto H, Hosaka M, Fujii H, et al. Successful management of a blunt pancreatic trauma by endoscopic stent placement. Clin J Gastroenterol 2010; 3:204–8.
14. Keil R, Drabek J, Lochmanova J, et al. What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children? Scandinavian Journal of Gastroenterology 2016; 51:218−24.
15. Paul MD, Money DP. The management of pancreatic injuries in children: operate or observe. J Pediatr Surg 2011;46:1140–3.
16. Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int 2013;29:1019–22.
17. Šnajdauf J, Rygl M, Kalousová J, et al. Surgical management of major pancreatic injury in children. Eur J Pediatr Surg 2007;17:317−21.
18. Wood JH, Partrick DA, Bruny JL, et al. Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg 2010;45:401–6.
19. Sharma SS, Sudhir Maharshi S. Endoscopic management of pancreatic pseudocyst in children – a long-term follow-up. J Pediatr Surg 2008;43:1636–9.
20. Russell KW, Barnhart DC, Madlen J, et al. Non-operative treatment versus percutaneous drainage of pancreatic pseudocysts in children. Pediatr Surg Int 2013;29:305–10.
21. Bahattin A, Serkan A, Hikmet Z, et al. Predicting pseudocyst formation following pancreatic trauma in pediatric patients. Pediatr Surg Int 2016;32:559–63.
22. Clifton MS, Pelayo JC, Cortes RA, et al. Surgical treatment of childhood recurrent pancreatitis. J Pediatr Surg 2007;42:1203–7.
23. Ray S, Sanyal S, Ghatak S, et al. Frey procedure for chronic pancreatitis in children: A single center experience. J Pediatr Surg 2015;50:1850–3.
24. Casamassima MGS, Goldstein SD, Yang J, et al. The impact of surgical strategies on outcomes for pediatric chronic pankreatitis. Pediatr Surg Int 2017;33:75–83.
25. Montero M, Vazquez JL, Rihuete MA, et al. Serous cystadenoma of the pancreas in a child. J Pediatr Surg 2003; 38:E36.
26. Costa S , Sucesso MB, Ferreira AM, et al. Pancreatic serous cystadenoma in a child Eur J Pediatr Surg 2011;21:266–7.
27. Peranteau WH, Andrew A. Palladino AA, et al. The surgical management of insulinomas in children J Pediatr Surg 2013;48:2517–24.
28. Graf TG, Brendle M, Clerici T, et al. Insulinoma: only in adults?—case reports and literature review. Eur J Pediatr 2014;173:567–74.
29. Kang ChM, Choi SH, Kim SCh, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection. Annals of Surgery 2014;260:348−55.
30. Snajduf J, Pycha K, Rygl M, et al. Papillary cystic and solid tumor of the pancreas – surgical therapy with the use of CUSA, and review of the pediatric literature. Eur J Pediatr Surg 1999;9:416−9.
31. Choi SH, Kim SM, Oh JT, et al. Solid pseudopapillary tumor of the pancreas: a multicenter study of 23 pediatric cases. J Pediatr Surg 2006;41:1992–5.
32. Rojas Y, Warneke CL, Dhamne ChA, et al. Primary malignant pancreatic neoplasm in children and adolescents: A 20 year experience. J Pediatr Surg 2012;47:2199−204.
33. Snajdauf J, Rygl M, Petru O, et al. Duodenum - sparing technique of head resection in solid pseudopapillary tumor of the pancreas in children. Eur J Pediatr Surg 2009;19:354−7.
34. Zampieri N, Schiavo N, Capella P, et al. Pseudopapillary tumor in pediatric age: clinical and surgical management. Pediatr Surg Int 2011;27:1271–5.
35. Speer AL, Barthel ER, Patel MM, et al. Solid pseudopapillary tumor of the pancreas: a single-institution 20-year series of pediatric patients Journal of Pediatric Surgery 2012;47:1217–22.
36. Perez EA: Gutierrez JC, Leonidas G, et al. Malignant pancreatic tumors – incidence and outcome in 58 pediatric patiens. J Pediatr Surg 2009;44:197–203.
37. Ellerkamp V, Warmann SW, Forberk P, et al. Exocrine pancreatic tumors in childhood in Germany. Pediatr Blood Cancer 2012;58:366−37.
38. d‘Ambrosio G, del Prete L, Grimaldi Ch, et al. Pancreaticoduodenectomy for malignancies in children. J Pediatr Surg 2014;49:534–8.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2018 Issue 3
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