Organ-preserving surgery for solid pseudopapillary neoplasm of the pancreas: A multicentric study

BACKGROUND: Solid pseudopapillary neoplasms (SPNs) are rare, indolent pancreatic tumors characterized by an excellent prognosis, with a predilection for young females. While organ-preserving surgical approaches are gaining traction in clinical practice, the standard treatment for SPNs continues to rely on non-organ-preserving resection techniques-a strategy originally adapted from the management of pancreatic adenocarcinoma, a more aggressive tumor subtype. METHODS: This multicentric study employed a two-cohort design. A training set (n = 1035) from a single center and an independent validation set (n = 1200) from 13 centers were analyzed. Patients undergoing radical resection were classified into organ-preserving or common surgery groups. Propensity score matching balanced covariates (age, sex, tumor size/location). RESULTS: The proportion of organ-preserving surgery gradually increased in both cohorts from 2010 to 2025, from 28.6% to 78.4% in the training set and from 37.5% to 64.7% in the validation set. After propensity score matching, organ-preserving surgery demonstrated significantly shorter operative times, reduced intraoperative blood loss, and lower transfusion rates in both cohorts. While the incidence of clinically relevant (grade B) postoperative pancreatic fistula was higher with organ-preserving, rates of severe (grade C) fistula, reoperation, and 90-day mortality were comparable. Critically, no significant differences in recurrence-free survival or overall survival were observed between the organ-preserving and traditional surgery groups, either before or after matching. CONCLUSIONS: Organ-preserving surgery is the preferred surgical approach for SPN, aligning curative intent with enhanced quality of life, particularly for its young, predominantly female patient population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07183280.