title: Laparoscopic Resection of Pancreatic Tumors in Children: Results of a Multicentric Survey.
abstract: OBJECTIVE
  This study aimed to report the results of a multicentric survey about laparoscopic treatment of pancreatic tumors in children.
  
  
  METHODS
  The data of patients operated using minimally invasive surgery (MIS) for a pancreatic tumor in 5 International centers of Pediatric Surgery in the last 5 years were retrospectively reviewed. We recorded data relating to the clinical presentation, diagnostic evaluation, surgical technique, and outcome.
  
  
  RESULTS
  Fifteen patients (average age 2.2 years) were identified. The most common symptoms at presentation were related to the hypoglycemic hyperinsulinism, followed by abdominal pain and vomiting. Tumor types were insulinoma (n = 4), congenital hyperinsulinism of infancy (CHI) diffuse type (n = 3), CHI focal type (n = 3), solid pseudopapillary tumor (n = 2), and cystic malformation (n = 3). The diagnostic assessment was completed using ultrasound associated with computed tomography (CT) scan in all centers;18FDOPA positron emission tomography in combination with CT was adopted in 2 centers. The MIS procedures performed were as follows: tumor enucleation (n = 4), distal pancreatectomy (n = 8), subtotal pancreatectomy (n = 2), and pancreatico-jejunostomy (n = 1). Average operative time was 110 minutes. As for postoperative complications, we recorded 1 persistent hypoglycemia, requiring redo-surgery (IIIb Clavien-Dindo) and 1 thrombosis of splenic vein, not requiring any treatment (I Clavien-Dindo).
  
  
  CONCLUSIONS
  Laparoscopic resection can be considered a safe and effective treatment with minimal morbidity and excellent outcomes for most pediatric pancreatic tumors. Suspension of the stomach with a transparietal stitch and use of new hemostatic devices as Starion TLS3 or Ligasure are key factors for the success of the procedure. A long-term follow-up is mandatory in these patients to evaluate postoperative complications and long-term outcome.
authors.affiliation: 1 Department of Translational Medical Sciences, Pediatric Surgery Unit, Federico II University of Naples , Naples, Italy .
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: 1 Department of Translational Medical Sciences, Pediatric Surgery Unit, Federico II University of Naples , Naples, Italy .|2 Department of Pediatric Surgery, Hôpital d'Enfants de La Timone , Marseille, France .
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
authors.affiliation: 1 Department of Translational Medical Sciences, Pediatric Surgery Unit, Federico II University of Naples , Naples, Italy .
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: 3 Department of Pediatric Surgery, Chelsea Children Hospital , London, United Kingdom .
authors.forename: Amulya
authors.initials: A
authors.lastname: Saxena
authors.affiliation: 4 Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.affiliation: 1 Department of Translational Medical Sciences, Pediatric Surgery Unit, Federico II University of Naples , Naples, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.affiliation: 5 Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg , Strasbourg, France .
authors.forename: Francois
authors.initials: F
authors.lastname: Becmeur
authors.affiliation: 6 Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre , Utrecht, The Netherlands .
authors.forename: David
authors.initials: D
authors.lastname: van der Zee
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D044903:Congenital Hyperinsulinism / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010181:Pancreatic Cyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods; D000072078:Positron Emission Tomography Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology
keywords: MIS; children; laparoscopy; pancreatic tumors; resection