Pediatric pancreatectomy for neoplasms: indications, outcomes, and implementation of minimally invasive surgery in a Ukrainian tertiary center

Abstract Purpose Pancreatic neoplasms are rare in children, resulting in limited data on pancreatectomy within this population. Our case series aims to contribute to the understanding of the indications, long- and short-term outcomes of surgical treatment for both benign and malignant pancreatic neoplasms in children. Methods This is a retrospective review of pediatric patients (≤ 18 years old) who underwent resection for pancreatic neoplasms in a single tertiary referral center from July 2003 to November 2023. Results Overall, 31 patients with a median age of 13 years (range 1–15) were included in the study. Solid pseudopapillary neoplasm was diagnosed in 15 (48%) patients, neuroendocrine tumor– 7 (23%), serous cystadenoma– 2 (6%), pancreatic ductal adenocarcinoma– 2 (6%), pancreatoblastoma– 2 (6%), and lymphoma– 1 (3%). There were two rare cases of mature cystic teratoma and pancreatic paraganglioma. 20 (65%) distal pancreatectomies, 7 (23%) pancreaticoduodenectomies, and 4 (13%) tumor enucleations were performed. The laparoscopic approach was applied in 9 (29%) cases in the last seven years. There were 4 (13%) complications Clavien-Dindo ≥ 3, and no cases of perioperative mortality. The median follow-up was 114 months (range 10–131 months). 87% (27/31) of patients were alive without tumor recurrence. Conclusions Surgical treatment remains the best chance for cure in patients with pancreatic neoplasms. These complex surgeries can be safely performed in the pediatric population with good long-term results. Advances in minimally invasive technique allow transition to less traumatic surgery in these patients

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien–Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)