A long-term survival offered by resection of solid-pseudopapillary tumor of the pancreas?

The article published in volume 14 issue 6 of World Journal of Gastroenterology reports on one patient who presented to Dr Cosimo Sperti of University of Padua, Padova, Italy, in 2001 after an exploratory laparotomy performed in another hospital for an unresectable pancreatic cystic mass that had infiltrated the portal vein.

Total pancreatectomy together with resection and reconstruction of portal vein was then successfully performed.Histopathologic examination showed a solid-pseudopapillary tumor of the pancreas infiltrating the layer of the portal vein.

Thirty-two months later, multiple hepatic metastases occurred. Percutaneous biopsy confirmed hepatic localization of solid-pseudopapillary tumor of the pancreas. The patient underwent multiple chemotherapeutic regimens that have resulted in a substantially stable disease until the present time, 75 months after the initial pancreatic resection.

To better understand the impact of surgery and chemotherapy on the prognosis of this rare tumor, Dr. Cosimo Sperti reviewed 25 patients from medical English literature with infiltrating solid-pseudopapillary neoplasm of the pancreas. Treatment of metastatic disease was also analyzed.

On the basis of the present case and the published literature, Dr. Cosimo Sperti has proposed the indications of aggressive surgery, whenever possible, even in advanced tumors, and in centers with high volume of pancreatic surgery. Although standard chemo-radiotherapeutic regimens do not exist, a multimodality approach (i.e. surgery, chemotherapy and/or radiotherapy) may offer long-term survival prospects even in dealing with advanced tumors.