Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases

Background: Solid pseudopapillary neoplasms of the pancreas (SPN-P) are rare, low-grade malignancies primarily affecting young women. While surgical resection is definitive, the optimal balance between oncological radicality and functional preservation remains a clinical challenge. This study evaluates tailored surgical strategies utilizing minimally invasive and parenchyma-preserving techniques. Patients and Methods: We conducted a multi-institutional retrospective analysis of SPN-P cases treated between March 2020 and May 2023. Out of 167 pancreatic resections, five paradigmatic cases were identified. We analyzed the decision-making process for preoperative staging (CT/MRI/EUS-FNB), surgical approach (open, laparoscopic, or robotic), and the implementation of parenchyma-preserving versus formal resections. Results: The cohort included four females and one male (mean age 40.6 years; range 13–73). Surgical approaches were tailored to tumor location and patient characteristics: two patients underwent pancreatoduodenectomy (one laparotomic, one laparoscopic), two underwent distal pancreatectomy (one robotic, one laparoscopic), and one pediatric patient underwent laparoscopic parenchyma-preserving central pancreatectomy. R0 resection was achieved in all cases. No Grade B/C postoperative pancreatic fistulas (POPF) or complications Clavien-Dindo ≥III occurred. At a mean follow-up (FU) of 38.4 months (range 20–58), the disease-free survival rate was 100%. One patient developed new-onset diabetes mellitus following distal pancreatectomy. Conclusions: A tailored surgical approach—integrating robotic, laparoscopic, and parenchyma-preserving techniques—may enable excellent oncological outcomes while minimizing morbidity. For SPN-P, the choice of procedure should prioritize the preservation of pancreatic function, particularly in young patients, without compromising surgical margins.