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Solid-pseudopapilläre Neoplasien des Pankreas

Diagnostik, chirurgische Therapie und postoperatives Outcome

Solid pseudopapillary neoplasms of the pancreas

Diagnostics, surgical treatment and postoperative outcome

Der Chirurg volume 93, pages 72–81 (2022)Cite this article

Zusammenfassung

Hintergrund

Bei den malignen soliden pseudopapillären Neoplasien (SPN) handelt es sich um eine seltene Tumorentität des Pankreas. Die Prognose der SPN ist generell exzellent, allerdings haben einige Tumoren ein malignes Potenzial und neigen zur Metastasierung bzw. zum Rezidiv.

Ziel der Studie

Untersucht werden soll, ob es histopathologische oder operationstechnische Risikofaktoren gibt, die das biologische Potenzial von SPN einschätzen lassen.

Patienten und Methoden

Das Patientenkollektiv aus 2 großen deutschen Pankreaszentren aus den Jahren 2009 bis 2018 wird in Bezug auf das Vorkommen von SPN, das chirurgische Management, histopathologische Tumorcharakteristika und das postoperative Outcome evaluiert.

Ergebnisse

Es wurden 22 Patienten (17 Frauen, 5 Männer) mit SPN operiert. Das Alter der Patienten lag im Median bei 37 Jahren (Range 19–69 Jahre). Zum Zeitpunkt der Resektion zeigten 20 Patienten ein auf das Pankreas begrenztes Tumorwachstum. Eine Patientin mit Rezidiv einer auswärts resezierten SPN wies einen Lymphknotenbefall auf. Eine weitere Patientin hatte ein hepatisch metastasiertes Rezidiv (Union Internationale contre Cancer (UICC)-Stadium IV) einer auswärtig resezierten SPN. Während sämtliche Patienten im Rahmen des Follow-ups rezidivfrei überlebten, entwickelte diese Patientin erneut Leberfiliae. Die Überlebensrate bis zum Ende des Follow-ups (Median 43 Monate; Range 1–132 Monate) dieser Studie lag bei 100 %.

Diskussion

Es mangelt an Kenntnissen bezüglich möglicher Parameter, die das biologische Verhalten von SPN vorhersagen lassen. Außer einer erhöhten Rezidivwahrscheinlichkeit nach Resektion eines SPN-Rezidives ließen sich am untersuchten Patientenkollektiv keine klaren Risikofaktoren ausmachen, die auf ein gesteigertes malignes Potenzial und ein möglicherweise schlechteres Outcome hinweisen könnten. Nur eine radikale operative Resektion mit Lymphadenektomie ermöglicht eine sichere Abschätzung des Tumorstadiums und eine Entfernung möglicherweise betroffener Lymphknoten, die beim Belassen Ursache eines Rezidivs sein könnten.

Abstract

Background

Malignant solid pseudopapillary neoplasms (SPN) are rare tumor entities of the pancreas. The prognosis for SPN is generally excellent, although some tumors have malignant potential and tend to metastasize or relapse.

Objective

The aim was to investigate whether there are histopathological or surgical risk factors that enable the biological potential of SPN to be estimated.

Patients and methods

Data from patients with SPN treated in two large German pancreas centers from 2009 to 2018 were evaluated with respect to the occurrence of SPN, surgical management, histopathological tumor characteristics and the postoperative outcome.

Results

A total of 22 patients with SPN (17 women, 5 men) were operated on. The median age of the patients was 37 years (range 19–69 years). At the time of surgery 20 patients showed tumor growth limited to the pancreas. A female patient with recurrence of an externally resected SPN had lymph node involvement. Another female patient had a hepatic metastatic recurrence (Union Internationale contre Cancer (UICC) stage IV) of an externally resected SPN. Although all patients survived recurrence-free during the follow-up, this patient developed liver metastases again. The survival rate up to the end of the follow-up (median 43 months; range 1–132 months) of this study was 100%.

Conclusion

There is a lack of knowledge of the possible parameters that can be used to predict the biological behavior of SPN. Apart from an increased likelihood of recurrence after resection of an SPN recurrence, no clear risk factors could be identified in the examined patient collective that could indicate an increased malignant potential and a possibly poorer outcome. Only a radical surgical resection with lymphadenectomy enables a reliable assessment of the tumor stage and the removal of possibly affected lymph nodes, which could be the cause of a recurrence if left intact.

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Author information

Affiliations

  1. Abteilung für Chirurgie, Christliches Klinikum Unna, Obere Husemannstr. 2, 59423, Unna, Deutschland

    Sabine Kersting

  2. Klinik für Allgemein- und Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Mara Götz, Faik Güntac Uzunoglu & Jakob Robert Izbicki

  3. Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland

    Waldemar Uhl &  Monika Silvia Janot-Matuschek

  4. Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Niclas Christian Blessin

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  1. Sabine Kersting
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  7. Monika Silvia Janot-Matuschek
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Correspondence to Monika Silvia Janot-Matuschek.

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Interessenkonflikt

S. Kersting, M. Götz, F.G. Uzunoglu, W. Uhl, J.R. Izbicki, N.C. Blessin und M.S. Janot-Matuschek geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Kersting, S., Götz, M., Uzunoglu, F.G. et al. Solid-pseudopapilläre Neoplasien des Pankreas. Chirurg 93, 72–81 (2022). https://doi.org/10.1007/s00104-021-01420-x

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Schlüsselwörter

  • Solide pseudopapilläre Neoplasie
  • Pankreastumor
  • Wachstumsverhalten
  • Prognoseparameter
  • Outcome

Keywords

  • Solid pseudopapillary neoplasm
  • Pancreatic tumor
  • Growth behavior
  • Prognostic parameters
  • Outcome