Surgical and functional outcomes of pediatric pancreatic solid pseudopapillary neoplasm: A retrospective study

Background Pediatric pancreatic solid pseudopapillary neoplasm (SPN) is rare, but it represents a clinically important pancreatic tumor in children. The optimal operative strategy remains uncertain, particularly the balance between tumor clearance, postoperative morbidity, and preservation of pancreatic function. This study evaluated surgical, oncologic, and functional outcomes after a selective strategy incorporating parenchyma-preserving procedures. Methods A retrospective cohort study included patients aged ≤16 years who underwent surgery for pathologically confirmed SPN at a tertiary hospital from January 2021 to December 2024. Clinical, imaging, operative, pathologic, postoperative, recurrence, and pancreatic functional outcomes were reviewed. Results Thirty-two patients were included; 28 were female (87.5%), and the mean age was 11.1 ± 2.1 years. Abdominal pain was the most common presentation (81.3%). The median tumor diameter was 42.5 mm (range, 19–120). Tumors were located in the pancreatic head in 15 patients (46.8%) and the body/tail in 17 (53.2%). Parenchyma-preserving procedures were performed in 19 patients (59.4%). Distal pancreatectomy was performed in 12 patients, with spleen preservation in 9. Early complications occurred in 5 patients, all with pancreatic head tumors, including one grade C pancreatic fistula that required reoperation. There was no mortality. R0 resection was achieved in 21 patients (65.6%). During a mean follow-up of 34.4 ± 9.8 months, one local recurrence occurred after R1 pancreatic head enucleation and was treated with pancreaticoduodenectomy. No clinically recognized endocrine insufficiency developed. Transient exocrine insufficiency occurred in 11 of 26 assessed patients and resolved in all. Exploratory subgroup analyses were underpowered and did not establish equivalent outcomes between operative strategies or margin groups. Conclusions Parenchyma-preserving surgery was feasible in selected children with SPN, but pancreatic head enucleation carried fistula and margin-related concerns. These findings support selective rather than routine pancreatic preservation, with structured long-term surveillance.