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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Pancreatic neoplasms are very rare in children and available data in this field are limited. Surgery allows the long-term survival of these patients, even if it could lead to complications such as pancreatic insufficiency. Currently there is little evidence on the onset of pancreatic failure and growth trend in children after pancreatic surgery.
Research motivation
We would like to increase knowledge regarding the evolution of pancreatic function after surgical resection in children with pancreatic neoplasms. Currently there is no scheduled follow-up to monitor the long-term complications of pancreatic surgery and in pediatric age it is essential to immediately diagnose the possible onset of pancreatic insufficiency to ensure adequate growth.
Research objectives
The aim of this study was to evaluate the long-term outcome of pancreatic function after pancreatic surgery in children, identify the incidence of endocrine and exocrine pancreatic insufficiency, fat-soluble vitamin deficiency and failure to thrive.
Research methods
We retrospectively analyzed all consecutive pediatric patients diagnosed with pancreatic neoplasms who underwent pancreatic surgery in our institution between January 31, 2002 and the present. Patients were followed by a multidisciplinary team that assessed auxological parameters, clinical symptoms, laboratory and radiological tests at each follow-up visit.
Research results
Sixteen patients (12 girls and 4 boys, mean age 10.7 ± 5.3 years), were included. The most frequent surgery was pancreaticoduodenectomy (50%). Exocrine failure occurred in 4 patients (25%) within 6 mo after surgery, while endocrine failure occurred in 2 patients (12.5%) 8 and 10 years after surgery, respectively. No statistically significant differences were found in BMI z-score at diagnosis and at the last follow-up. Vitamin D was insufficient (< 30 ng/mL) in 8 of the 16 patients while vitamins A, E and clotting test were into the normal ranges in all patients.
Research conclusions
Our study highlights that the development of exocrine and endocrine pancreatic insufficiency after pancreatic surgery is not rare; these potential complications must be adequately identified and treated, as pancreatic enzyme replacement therapy prevents malabsorption and consequent growth failure.
Research perspectives
It is essential to identify and establish a standardized follow-up in pediatric patients, organized by a multidisciplinary team including a surgeon, oncologist, gastroenterologist, endocrinologist, radiologist and dietician.
