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

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.