Solid pseudopapillary tumor of the pancreas: Can malignancy be predicted?

Background. The objective of this study was to examine the clinicopathologic characteristics of solid pseudopapillary tumors (SPTs) of the pancreas, including the risk factors for disease recurrence and their effects on survival. Methods. The medical records of 114 patients who underwent surgery for a pathologically confirmed SPT between January 1995 and December 2007 were reviewed retrospectively. Results. Of the 114 patients, 98 (86.9%) were female, and the median. age was 36 years (range, 11-75). All 114 patients underwent curative intent surgery and 13 (11.4%) underwent laparoscopic surgery. Of the 114 patients, 26 (22.8%) had solid pseudopapillary carcinoma (SPC). There were 710 differences in any clinical factors between the benign SPT and SPC groups; however; the only 4 recurrences identified were in the SPC group. After follow-up ranging from 11 to 177 months, all 114 patients were alive, with only 4 showing evidence of recurrence. Recurrence was observed in young patients with metastasis at first operation, invasion of an adjacent organ, and a large mass (>= 13 cm). Conclusion. Adequate operative resection including laparoscopic surgery is the mainstay of treatment for SPT Although statistically significant risk factors for recurrence cannot be determined, tumor metastasis at the first operation, invasion of adjacent organ, large tumor size, young patient age, tumor rupture, and inadequate resection may increase the risk of recurrence. Our results demonstrate that long-term survival could be achieved by aggressive operative resection and interventional treatment of recurrent disease. (Surgery 2011;149:625-34.)