Splenic preservation in minimally invasive pancreatic resection in children

Pancreatic resections in children are rare, with limited consensus on the optimal surgical approach for achieving oncologic safety while preserving pancreatic and splenic function. Minimally invasive pancreatic surgery, particularly with splenic preservation, is increasingly adopted in adult practice but remains underreported in pediatric populations. We conducted a single center retrospective study of patients under 18 years old who underwent minimally invasive pancreatic resection with splenic preservation for surgical conditions between 2013 and 2023. Outcomes assessed included feasibility, intra- and postoperative complications, histologic results, and long-term pancreatic function. Fourteen patients met inclusion criteria. The majority were female (78.6%) with a mean age of 9.7 ± 5.6 years. Most lesions were localized in the pancreatic body and tail (71.5%), and solid pseudopapillary neoplasm was the most frequent histologic diagnosis (57.1%). All patients underwent successful laparoscopic resections without intraoperative complications. Negative margins were obtained in 78.6% of cases. Postoperative complications occurred in 3 patients (21.4%), one Clavien-Dindo grade I and two grade IIIB; and long-term follow-up revealed 3 cases of persistent endocrine or exocrine dysfunction. No tumor recurrences were observed. Minimally invasive pancreatic resection with splenic preservation is a feasible and safe option in selected pediatric patients with benign or low-grade malignant tumors. This approach is associated with favorable perioperative outcomes, preservation of immune function, and minimal long-term morbidity, supporting its broader adoption in pediatric surgical oncology.