Clinical Characteristics of Adolescent and Young Adult Patients Undergoing Pancreatectomy for Malignant Tumors: A 20-Year Single Institution Experience

<b><i>Background and Aim:</i></b> Adolescent and young adult (AYA) patients who require pancreatectomy are rare. There are few reports concerning the characteristics of AYA patients undergoing pancreatectomy for malignant tumors. This study aimed to clarify the characteristics and outcomes of AYA patients who had undergone pancreatectomy. <b><i>Methods:</i></b> AYA patients (age 15-35 years) who underwent pancreatectomy at our institution between 1995 and 2018 were included in this study. The diagnosis, operative procedure, complications, mortality, and survival were retrospectively analyzed. <b><i>Results:</i></b> Forty-seven patients underwent pancreatectomy (median age 29 years; range, 16-35 years). The diagnoses were solid-pseudopapillary neoplasm (SPN; <i>n</i> = 21 [44.6%]), neuroendocrine neoplasm (NEN; <i>n</i> = 12 [25.5%]), adenocarcinoma (<i>n</i> = 5 [10.6%]), and others (<i>n</i> = 9 [19.1%]). The surgical procedures included pancreatoduodenectomy (PD; <i>n</i> = 17 [36.1%]), distal pancreatectomy (DP; <i>n</i> = 18 [38.2%]), middle pancreatectomy (<i>n</i> = 8 [17.0%]), and tumor enucleation (<i>n</i> = 4 [8.5%]). The most common postoperative complication was pancreatic fistula (POPF) (<i>n</i> = 29 [61.7%]). Hemorrhage was noted in one case, but the surgical mortality rate was 0%. Long-term complications included four cases of pancreatitis, three cases of diabetes, two cases of bowel obstruction, and one case of cholangitis. The 5-year recurrence-free-survival (RFS) and overall-survival (OS) rates in patients with SPN/NEN/others were 91.8% and 97.5%, respectively. In contrast, the 5-year RFS and OS rates in patients with adenocarcinoma were 53.3% and 80.0%, respectively. <b><i>Conclusion:</i></b> Most AYA patients who underwent pancreatectomy had low-grade malignancies and showed a favorable survival. Although POPF and pancreatitis frequently occur, radical surgery-even major pancreatectomy such as PD and DP-is feasible and effective in AYA patients with malignant tumors.