Abstract: Clinical efficacy of minimally invasive surgery for solid pseudopapillary neoplasm of pancreas：A report of 89 cases in a single center        LIN Xian-chao, LIN Rong-gui, LU Feng-chun, et al. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail: heguanghuang2@163.com
Abstract    Objective    To investigate the clinical efficacy of minimally invasive surgery (including parenchyma-sparing pancreatectomy) in the treatment of solid pseudopapillary neoplasm (SPN) of the pancreas.  Methods    The clinical information of 89 patients with SPN of pancreas who underwent laparoscopic or robotic surgery in the Department of General Surgery of Fujian Medical University Union Hospital from January 2011 to September 2022 was retrospectively analyzed. The intraoperative and postoperative parameters were recorded. Results    Of the 89 patients, 7 (7.9%) were converted to laparotomy. 42 patients (47.2%) underwent laparoscopic surgery，and 47 patients (52.8%) underwent robotic surgery. There were 68 cases of conventional pancreatic surgery, and 21 cases of parenchyma-sparing pancreatectomy. The median operative time was 270 (90-840) min, and the median intraoperative blood loss was 100 (15-1500) ml. Postoperative complications occurred in 32 patients (36.0%), including 19 patients (21.3%) with postoperative pancreatic fistula (all grade B pancreatic fistula), 5 patients (5.6%) with abdominal infection, 4 patients (4.5%) with pulmonary infection, 2 patients (2.2%) with abdominal hemorrhage, 1 patient (1.1%) with biliary fistula, and 1 patient (1.1%) with delayed gastric emptying. The median length of postoperative hospital stay was 9 (4-45) days. The median follow-up was 43 (3-140) months,；all patients survived without recurrence or metastasis. Pancreatic endocrine insufficiency occurred in 12 patients (13.5%) and pancreatic exocrine insufficiency in 10 patients (11.2%). In the 21 cases of parenchyma-sparing pancreatectomy, the median operative time was 280(90-530)min and the median intraoperative blood loss was 50(15-500)ml. Postoperative complications occurred in 15 cases (71.4%), of which 11 cases (52.4%) had a pancreatic fistula (all grade B pancreatic fistula), and the median postoperative hospital stay was 15(4-39) days. There was one case (4.8%) of pancreatic endocrine insufficiency and exocrine insufficiency respectively. Conclusion    Minimally invasive surgical resection of SPN of pancreas was safe and feasible with good prognosis. Parenchyma-sparing pancreatectomy may help to protect pancreatic endocrine and exocrine function, but the incidence of postoperative pancreatic fistula was high. 

Key words: solid pseudopapillary neoplasm of the pancreas, laparoscopic surgery, robotic surgery, parenchyma-sparing pancreatectomy, pancreatic fistula

摘要： 目的    探讨微创手术（含保留胰腺实质手术）治疗胰腺实性假乳头瘤（SPN）的应用价值。方法    回顾性分析2011年1月至2022年9月福建医科大学附属协和医院基本外科收治的行腹腔镜或机器人手术治疗的89例胰腺SPN病人的临床资料。观察记录术中及术后情况。结果    89例病人中有7例（7.9%）中转开放手术。42例（47.2%）行腹腔镜手术，47例（52.8%）行机器人手术。其中规则切除术68例，保留胰腺实质手术21例。手术时间为270（90～840）min，术中出血100（15～1500）mL。32例（36.0%）病人出现术后并发症，包括19例（21.3%）术后胰瘘（均为B级胰瘘），5例（5.6%）腹腔感染，4例（4.5%）肺部感染，2例（2.2%）腹腔出血，1例（1.1%）胆瘘和1例（1.1%）胃排空延迟，无再手术病例。中位术后住院时间为9（4～45）d。随访43（3～140）个月，所有病人均存活，未见复发或转移。12例（13.5%）病人出现胰腺内分泌功能不全，10例（11.2%）病人出现胰腺外分泌功能不全。保留胰腺实质手术病人的手术时间为280（90～530）min，术中出血50（15～500）mL。15例（71.4%）病人出现术后并发症，其中11例（52.4%）为胰瘘（均为B级胰瘘），术后住院时间为15（4～39）d。术后出现胰腺内、外分泌功能不全各1例。结论  微创手术切除胰腺SPN安全可行，远期疗效良好；保留胰腺实质的胰腺切除术可能有助于更好保护胰腺内外分泌功能，但术后胰瘘发生率高。

关键词: 胰腺实性假乳头状瘤, 腹腔镜手术, 机器人手术, 保留胰腺实质手术, 胰瘘