Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7340-7349
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7340
Long-term outcome of pancreatic function following oncological surgery in children: Institutional experience and review of the literature
Giulia Bolasco, Teresa Capriati, Chiara Grimaldi, Lidia Monti, Maria Debora De Pasquale, Ippolita Patrizia Patera, Marco Spada, Giuseppe Maggiore, Antonella Diamanti
Giulia Bolasco, Teresa Capriati, Giuseppe Maggiore, Antonella Diamanti, Hepatology, Gastroenterology and Nutrition Unit, “Bambino Gesù” Children’s Hospital, IRCCS, Rome 00165, Italy
Chiara Grimaldi, Marco Spada, Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, "Bambino Gesù" Children's Hospital, IRCCS, Rome 00165, Italy
Lidia Monti, Radiology Department, "Bambino Gesù" Children’s Hospital, IRCCS, Rome 00165, Italy
Maria Debora De Pasquale, Hematology/Oncology Department, "Bambino Gesu" Children's Hospital, IRCCS, Rome 00165, Italy
Ippolita Patrizia Patera, Endocrinology and Diabetes Unit, "Bambino Gesù" Children’s Hospital, IRCCS, Rome 00165, Italy
Author contributions: All authors participated in the production of the work; all authors have read and approved the final manuscript.
Institutional review board statement: The Ethical Committee of “Bambino Gesù” Children’s Hospital in Rome approved this study. Our Hospital is an Institute authorized by the Ministry of Health Care for research and clinical study. Therefore, to enroll patients in clinical studies all the parents or tutors give their consent by signature of a specific document when the children are admitted to our Hospital. In this way, we have the consent in line with the indications of our Ethical Committee when the patients are admitted to the hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author or other coauthors and their contributions to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonella Diamanti, MD, Doctor, Hepatology, Gastroenterology and Nutrition Unit, “Bambino Gesù” Children’s Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome 00165, Italy. antonella.diamanti@opbg.net
Received: February 23, 2021
Peer-review started: February 24, 2021
First decision: March 29, 2021
Revised: April 13, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 6, 2021
Processing time: 188 Days and 12.9 Hours
Abstract
BACKGROUND

Pancreatic neoplasms are uncommon in children and in most cases they are benign or have low malignant potential. Pancreatoblastoma and solid pseudopapillary tumor are the most frequent types in early and late childhood, respectively. Complete resection, although burdened by severe complications, is the only curative treatment for these diseases. Pancreatic surgery may result in impaired exocrine and endocrine pancreatic function. However, limited data are available on the long-term pediatric pancreatic function following surgical resection.

AIM

To investigate endocrine and exocrine pancreatic function and growth after oncological pancreatic surgery in a pediatric series.

METHODS

A retrospective analysis of all pediatric patients who underwent surgery for pancreatic neoplasm in our Institution from January 31, 2002 to the present was performed. Endocrine and exocrine insufficiency, auxological and fat-soluble vitamin status (A, D, E and clotting tests) were assessed at diagnosis and at every follow-up visit. Exocrine insufficiency was defined as steatorrhea with fecal elastase-1 < 200 µg/g stool, while endocrine insufficiency was identified as onset of Diabetes or Impaired Glucose Tolerance. Growth was evaluated based on body mass index (BMI) z-score trend.

RESULTS

Sixteen patients (12 girls and 4 boys, mean age 10.7 ± 5.3 years), were included. Nine patients (56%) had a neoplasm in the pancreatic head, 4 in the body/tail, 2 in the tail and 1 in the body. Histological findings were as follows: Solid pseudopapillary tumor in 10 patients (62.5%), insulinoma in 2 patients, neuroendocrine tumor in 2 patients and acinar cell carcinoma in 2 patients. The most frequent surgery was pancreaticoduodenectomy (50%). Exocrine failure occurred in 4 patients (25%) and endocrine failure in 2 patients (12.5%). Exocrine insufficiency occurred early (within 6 mo after surgery) and endocrine insufficiency later (8 and 10 years after surgery). Mean BMI z-score was 0.36 ± 1.1 at diagnosis and 0.27 ± 0.95 at the last assessment. Vitamin D was insufficient (< 30 ng/mL) in 8 of the 16 patients during the follow-up period. Vitamins A, E and clotting test were into the normal ranges in all patients.

CONCLUSION

Careful and long-term monitoring should follow any pancreatic surgery, to recognize and promptly treat exocrine and endocrine pancreatic insufficiency, which can occur after surgery.

Keywords: Pancreatic neoplasms; Pancreatic function; Children; Malabsorption; Pancreatic failure; Growth

Core Tip: There are few published data on pediatric pancreatic neoplasms and, in particular, on the long-term outcome of pancreatic function and growth following surgery. Our findings, based on a retrospective review of 16 patients, showed that the development of exocrine (earlier) and endocrine failure (later) is not rare; careful and long-term monitoring of pancreatic function, can guarantee normal growth during early life.