title: Recurrence of Solid Pseudopapillary Neoplasms of the Pancreas: Results of a Nationwide Study of Risk Factors and Treatment Modalities.
abstract: Solid pseudopapillary neoplasms of the pancreas (SPPN) can relapse very late, but little is known about risk factors for recurrence and optimal treatment. We aimed to identify risk factors for recurrence and to analyze treatment modalities in all French pediatric cases of SPPN over the past 20 years.
  
  
  
  Data were collected from pediatric oncologists and surgeons, and also from adult pancreatic surgeons in order to identify late recurrences.
  
  
  
  Fifty-one patients (41 girls) were identified. Median age at diagnosis was 13.1 years [8.7-17.9]. Abdominal pain was the commonest presenting symptom (32/49, 65%). The tumor was located in the pancreatic head in 24 patients (47%). Preoperative biopsy or cytology was performed in 14 cases (28%). All patients were operated with a median of 23 days [0-163] after diagnosis. The rate of postoperative morbidity was 29%. With a median follow-up of 65 months [0.3-221], the overall and event-free survival was 100% and 71%, respectively. Seven patients (13.7%) relapsed with a median of 43 months [33-94] after initial surgery. Six were treated surgically, either alone (n = 3) or with perioperative chemotherapy (n = 2) or hyperthermic intraperitoneal chemotherapy (n = 1). One patient in whom further treatment was not feasible was still alive at last news. Risk factors for recurrence were positive surgical margins (P = 0.03) and age less than 13.5 years at diagnosis (P = 0.03).
  
  
  
  SPPN recurrence in this pediatric series was a rare and late event that did not undermine overall survival. Complete surgical removal of recurrent tumors appears to be the best option.
authors.affiliation: Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Department of Pathology, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Galmiche-Rolland
authors.affiliation: Clinical Research Unit/Clinical Investigation Centre, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.affiliation: Department of Pediatrics, Adolescents, Young Adults, Institut Curie, Groupe Fracture, French Rare Pediatric Tumors Group, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Orbach
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, Université Paris XI, Le Kremlin-Bicêtre, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Guérin
authors.affiliation: Department of Pediatric Hematology-Oncology, Aix-Marseille Univ and APHM, Hôpital d' Enfants de La Timone, Marseille, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Coze
authors.affiliation: Department of Pediatrics, Institut Leon Bérard, Lyon, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Faure-Conter
authors.affiliation: Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
authors.affiliation: Department of Pediatric Surgery, CHR de la Citadelle, Liège, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Demarche
authors.affiliation: Department of Pediatric Surgery, Lapeyronie-Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: René Benoît
authors.initials: RB
authors.lastname: Galifer
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Nancy-Brabois University Hospital, Vandoeuvre-lès-Nancy, France.
authors.forename: Marie Agnès
authors.initials: MA
authors.lastname: Galloy
authors.affiliation: Department of Pediatric Surgery, University Hospital, Angers, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
authors.affiliation: Department of Pediatric Surgery, University Hospital, Besançon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Aubert
authors.affiliation: Department of Pediatric Surgery, University Hospital, Grenoble, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Piolat
authors.affiliation: Department of Pediatric Surgery, Aix-Marseille Univ and APHM, Hôpital d'Enfants de La Timone, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
authors.affiliation: Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
mesh_terms: D000293:Adolescent; D002291:Carcinoma, Papillary / Q000401:mortality / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors
keywords: pancreas; pediatric; recurrence; solid pseudopapillary tumor; survival