Potential of endovideosurgery in the treatment of children with focal pancreatic lesions

   Aim. To evaluate the effectiveness of laparoscopic surgeries for diseases and malformations of the pancreas in children.

   Materials and methods. 53 laparoscopies were performed from 2005 to 2023. Enucleation was performed in 16 children, distal resection of the pancreas with spleen preservation – in 16, corpo-caudal resection of the pancreas – in 4, subtotal resection of the pancreas – in 9, central resection of the pancreas – in 5, head resection with duodenal preservation – in 1, pancreaticoduodenal resection with pyloric preservation – in 2 children. The age of the children ranged from 2 months to 17 years.

   Results. All surgeries have achieved the intended clinical effect. The average time of enucleation accounted for 88.1 ± 47.7 min., distal resection with spleen preservation – 100.3 ± 21 min., corpo-caudal resection – 113.3 ± 28.9
min., subtotal resection – 101 ± 21.7 min., central resection – 243.3 ± 81.1 min., head resection with duodenal preservation – 235 min., pancreaticoduodenal resection with pyloric preservation – laparoscopic and laparoscopically assisted – 435 and 415 min. Intraoperative bleeding was noted in 6 cases (11.3 %), in 2 (3.8 %) conversion was performed in 2 cases (3.8 %). The postoperative period revealed 6 (13.2 %) early and 8 (15.1 %) late complications. No fatal outcomes reported. The follow-up ranged from 1 to 10 years, no recurrences reported.

   Conclusion. Focal pancreatic lesions in children refer to heterogeneous diseases and malformations requiring various resection interventions. Laparoscopic enucleation and distal resection of the pancreas are considered as the most effective. Further clinical experience is required to explore the feasibility of using laparoscopy in children to perform central resection of the pancreas and pancreaticoduodenectomy.

1. Kubyshkin V.A., Kriger A.G., Vishnevskij V.A., Karmazanovskij G.G., Kochatkov A.V., Lebedeva A.N., Gorin D.S., Berelavichus S.V., Zagagov S.O., Filippova E.M. Pancreatectomy for the pancreatic tumors. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery. 2013; 3: 11–16. (In Russian)

2. Sacco Casamassima M.G., Gause C.D., Goldstein S.D., Abdullah F., Meoded A., Lukish J.R., Wolfgang C.L., Cameron J., Hackam D.J., Hruban R.H., Colombani P.M. Pancreatic surgery for tumors in children and adolescents. Pediatr. Surg. Int. 2016; 32 (8): 779–788. doi: 10.1007/s00383-016-3925-y

3. Rao K.L., Sunil I., Pimpalwar A., Vaiphei K., Chowdhary S. Intrapancreatic gastric duplication cyst presenting as lower gastrointestinal bleeding. J. Pediatr. Surg. 2003; 38 (2): 243–244. doi: 10.1053/jpsu.2003.50053

4. Waldhausen J.H., Holterman M.J., Tapper D. Identification and surgical management of cystic retroperitoneal lymphangioma in children. Pediatr. Surg. Int. 1996; 11 (4): 283–285. doi: 10.1007/BF00178441

5. Esposito C., De Lagausie P., Escolino M., Saxena A., Holcomb G.W. 3^rd, Settimi A., Becmeur F., van der Zee D. Laparoscopic resection of pancreatic tumors in children: results of a multicentric survey. J. Laparoendosc. Adv. Surg. Tech. A. 2017; 27 (5): 533–538. doi: 10.1089/lap.2016.0630

6. Adzick N.S., De Leon D.D., States L.J., Lord K., Bhatti T.R., Becker S.A., Stanley C.A. Surgical treatment of congenital hyperinsulinism: results from 500 pancreatectomies in neonates and children. J. Pediatr. Surg. 2019; 54 (1): 27–32. doi: 10.1016/j.jpedsurg.2018.10.030

7. Al-Taan O.S., Stephenson J.A., Briggs C., Pollard C., Metcalfe M.S., Dennison A.R. Laparoscopic pancreatic surgery : a review of present results and future prospects. HPB (Oxford). 2010; 12 (4): 239–243. doi: 10.1111/j.1477-2574.2010.00168.x

8. Kriger A.G., Gorin D.S., Pavlov A.V., Pronin N.A., Sidorov D.V., Kaldarov A.R., Ponezhev K.E., Panteleev V.I. Distal resection for pancreatic tumors. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2022; 27 (3): 55–62. doi: 10.16931/1995-5464.2022-3-55-62 (In Russian)

9. van Hilst J., de Rooij T., Bosscha K., Brinkman D.J., van Dieren S., Dijkgraaf M.G., Gerhards M.F., de Hingh I.H., Karsten T.M., Lips D.J., Luyer M.D., Busch O.R., Festen S., Besselink M.G.; Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol. Hepatol. 2019; 4 (3): 199–207. doi: 10.1016/S2468-1253(19)30004-4

10. de Vogelaere K., De Schepper J., Vanhoeij M., De Mey J., Goossens A., Vanbesien J., De Backer A., Delvaux G. Laparoscopic management of insulinoma in a child with multiple endocrine neoplasia type 1. J. Laparoendosc. Adv. Surg. Tech. A. 2006; 16 (3): 335–338. doi: 10.1089/lap.2006.16.335

11. Bax K.N., van der Zee D.C. The laparoscopic approach toward hyperinsulinism in children. Semin. Pediatr. Surg. 2007; 16 (4): 245–251. doi: 10.1053/j.sempedsurg.2007.06.006

12. Sokolov Y.Y., Stonogin S.V., Donskoy D.V., Povarnin O.Y., Vilesov A.V. Laparoscopic pancreatic resections for solid pseudopapillary tumor in children. Eur. J. Pediatr. Surg. 2009; 19 (6): 399–401. doi: 10.1055/s-0029-1237356

13. Wen Z., Wang J., Liang Q., Chang X., Zhang W., Niu H., He Q. Laparoscopic surgery for focal-form congenital hyperinsulinism located in pancreatic head. Front. Pediatr. 2022; 10: 919238. doi: 10.3389/fped.2022.919238

14. d'Ambrosio G., del Prete L., Grimaldi C., Bertocchini A., Lo Zupone C., Monti L., de Ville de Goyet J. Pancreaticoduodenectomy for malignancies in children. J. Pediatr. Surg. 2014; 49 (4): 534–538. doi: 10.1016/j.jpedsurg.2013.09.010

15. Nasher O., Hall N.J., Sebire N.J., de Coppi P., Pierro A. Pancreatic tumours in children: diagnosis, treatment and outcome. Pediatr. Surg. Int. 2015; 31 (9): 831–835. doi: 10.1007/s00383-015-3727-7

16. Patterson K.N., Trout A.T., Shenoy A., Abu-El-Haija M., Nathan J.D. Solid pancreatic masses in children : a review of current evidence and clinical challenges. Front. Pediatr. 2022; 10: 966943. doi: 10.3389/fped.2022.966943

17. Chung E.M., Travis M.D., Conran R.M. Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics. 2006; 26 (4): 1211–1238. doi: 10.1148/rg.264065012

18. Mylonas K.S., Doulamis I.P., Tsilimigras D.I., Nasioudis D., Schizas D., Masiakos P.T. Solid pseudopapillary and malignant pancreatic tumors in childhood : a systematic review and evidence quality assessment. Pediatr. Blood Cancer. 2018; 65 (10): e27114. doi: 10.1002/pbc.27114

19. Kovler M.L., Beckman R.M., Goldstein S.D., Stewart D. Laparoscopic spleen-preserving distal pancreatectomy for solid pseudopapillary neoplasm in adolescents. J. Laparoendosc. Adv. Surg. Tech. A. 2019; 29 (10): 1372–1377. doi: 10.1089/lap.2019.0201

20. Namgoong J.M., Kim D.Y., Kim S.C., Kim S.C., Hwang J.H., Song K.B. Laparoscopic distal pancreatectomy to treat solid pseudopapillary tumors in children: transition from open to laparoscopic approaches in suitable cases. Pediatr. Surg. Int. 2014; 30 (3): 259–266. doi: 10.1007/s00383-014-3471-4

21. Murase N., Uchida H., Tainaka T., Kawashima H., Tanaka Y., Amano H., Kishimoto H. Laparoscopic-assisted pancreaticoduodenectomy in a child with gastrinoma. Pediatr. Int. 2015; 57 (6): 1196–1198. doi: 10.1111/ped.12715

22. Komori K., Hirobe S., Tomaa M. A gastric duplication cyst of the pancreas associated with a bifid tail causing pancreatitis. Ped. Surg. Case Rep. 2013; 1 (10): 368–372. doi: 10.1016/j.epsc.2013.10.001

23. Sasaki N., Okamura M., Kanto S., Tatsumi K., Yasuda S., Kawabe A. Laparoscopic excision of a retroperitoneal completely isolated enteric duplication cyst in an adult male : a case report and review of literature. Int. J. Surg. Case Rep. 2018; 46: 1–5. doi: 10.1016/j.ijscr.2018.03.035

24. de Lagausie P., Bonnard A., Berrebi D., Lepretre O., Statopoulos L., Delarue A., Guys J.M. Abdominal lymphangiomas in children: interest of the laparoscopic approach. Surg. Endosc. 2007; 21 (7): 1153–1157. doi: 10.1007/s00464-006-9091-x

25. Butte J.M., San Francisco I.F., Pacheco F., Solar A., Crovari F.J., Jarufe N.P. Arteriovenous malformation of the pancreas: report of a case. Surg. Today. 2007; 37 (7): 604–607. doi: 10.1007/s00595-006-3459-3

26. Sharma M., Bedi M.M., Mahesh S., Gandhi M.D., Antony R., Mukkada R.J., Lekha V., Ramesh H. Arteriovenous malformation of the pancreatic head – difficulties in diagnosis and treatment. Indian J. Gastroenterol. 2011; 30 (1): 46–48. doi: 10.1007/s12664-010-0070-8

27. Song K.B., Kim S.C., Park J.B., Kim Y.H., Jung Y.S., Kim M.H., Lee S.K., Lee S.S., Seo D.W., Park D.H., Kim J.H., Han D.J. Surgical outcomes of pancreatic arteriovenous malformation in a single center and review of literature. Pancreas. 2012; 41 (3): 388–396. doi: 10.1097/MPA.0b013e31822a25cc

28. Vogel A.M., Alesbury J.M., Fox V.L., Fishman S.J. Complex pancreatic vascular anomalies in children. J. Pediatr. Surg. 2006; 41 (3): 473–478. doi: 10.1016/j.jpedsurg.2005.10.079

29. Gubaeva D.N., Melikyan M.A., Ryzhkova D.V., Poyda M.D., Bairov V.G., Sukhotskaya A.A., Sokolov Yu.Yu., Efremenkov A.M., Mitrofanova L.B., Christesen H., Nikitina I.L. Clinical, genetic, and radionuclide characteristics of the focal form of congenital hyperinsulinism. Problemi Endocrinologii = Problems of Endocrinology. 2019; 65 (5): 319–329. doi: 10.14341/probl10317 (in Russian)

30. Galganski L.A., Hirose S., Saadai P. Resection of a thoraco-abdominal ganglioneuroma via a retroperitoneal minimally invasive approach. J. Pediatr. Surg. Case Rep. 2019; 40: 47–49. doi: 10.1016/j.epsc.2018.10.012