title: Clinical presentation and comparison of surgical outcome for segmental resection vs. Whipple's procedure for solid pseudopapillary tumor: Report of six new cases & literature review of 321 cases.
abstract: OBJECTIVE
  Report 6 new cases of solid-pseudopapillary-pancreatic-tumor, comprehensively review 321 cases reported in American literature, and compare outcomes for segmental resection vs.. Whipple's procedure.
  
  
  METHODS
  Cases of solid-pseudopapillary-tumor at William Beaumont Hospital, 1999-2011, identified by computerized analysis of pathology reports. Comprehensive review of all American cases identified by computerized literature review. Segmental resection includes open/laparoscopic central pancreatectomy and anatomic distal pancreatectomy, but excludes enucleation.
  
  
  RESULTS
  Six cases of solid-pseudopapillary-pancreatic-tumors (0.5% of all solid pancreatic lesions), occurred during 1999-2011 at the hospital. Mean age at diagnosis = 27.7 years. All 6 were female. All patients had abdominal pain. Mean symptom duration = 10.0 days. All patients had normal routine blood tests. Mean APACHE II score at diagnosis = 1.8. All six patients had single heterogeneous lesions, with cystic/solid components. All patients underwent surgery: segmental resection-4, Whipple's procedure-2. Tumors were uniformly diagnosed by surgically resected tissue. Mean tumor size = 5.7 cm. Mean postoperative length of stay = 4.0 days for segmental resection (N = 4) vs. 14.0 days for Whipple's procedure (N = 2). All 6 patients are alive and well to-date, without evident local recurrence or metastasis. In a literature review, 45 patients undergoing Whipple's procedure versus 34 patients undergoing segmental resection, had significantly longer mean postoperative hospitalization (16.4 vs. 4.3 days, p = 0.01), and had increased unadjusted mortality (20.2% vs. 2.2%, p = 0.018). However, this mortality difference became insignificant when adjusting for longer mean follow-up of Whipple's procedure patients (Kaplan-Meier-survival-curve, p = 0.75).
  
  
  CONCLUSIONS
  This work suggests segmental resection of these pancreatic tumors localized to the body/tail may have a better surgical outcome than Whipple's procedure for tumors localized to the pancreatic head. Further studies are necessary.
authors.affiliation: Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Vinayata
authors.initials: V
authors.lastname: Manuballa
authors.affiliation: William Beaumont Hospital, Royal Oak, MI, USA; Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA.
authors.forename: Mitual
authors.initials: M
authors.lastname: Amin
authors.affiliation: William Beaumont Hospital, Royal Oak, MI, USA; Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA. Electronic address: mscappell@yahoo.com.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cappell
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology
keywords: Nonneuroendocrine pancreatic tumor; Oncology; Pancreatic neoplasms; Prognosis; Segmental resection; Solid pseudopapillary tumor; Surgical mortality; Surgical outcomes; Whipple's procedure