Feasibility and limitations of organ‐preserving surgery for solid pseudopapillary neoplasm of the pancreas in children

Purpose Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare and predominantly affect females and adolescents, with excellent outcomes after resection. In pediatric patients, organ‐preserving surgery is preferred to maintain long‐term pancreatic function. Methods A retrospective review of surgical procedures and postoperative complications was conducted for children who received surgical treatment for SPN at our institution from 2000 to 2024. Results Eight patients (median age, 12 [8–14] years) were included. Initial presentations included abdominal pain ( n = 2), blunt trauma ( n = 3), and incidental diagnosis ( n = 3). Tumor (median diameter, 42.5 [28–80] mm) locations included the pancreatic head ( n = 3), body ( n = 1), and tail ( n = 4). Enucleation was performed in three patients, all of whom developed postoperative pancreatic fistula (POPF). One patient with a head tumor required pancreatoduodenectomy because of portal vein involvement with cavernous formation, which caused postoperative glucose intolerance and pancreatic atrophy. Distal pancreatectomy was performed in four patients with tail tumors, with spleen preservation in three and splenectomy in one due to collateral development. POPF occurred in two patients. No recurrence was observed during a median follow‐up period of 66.5 months (16–120). Conclusion While organ‐preserving surgery for SPN in children is feasible, it carries a significant risk of POPF, particularly with EN. Long‐term monitoring of pancreatic function after resection is essential.