Pancreatic cysts in children: diagnostical and surgical tactics

BACKGROUND: Surgical treatment of pancreatic cysts is one of the most difficult procedures in pediatric surgery. In children with pancreatic cysts, the issues of differential diagnosis and determining the connection of the cyst cavity with the main pancreatic duct remain problematic. Recent publications have focused on the use of endoscopic ultrasonography in pediatric practice to visualize the parenchyma and the ductal system of the pancreas with high accuracy.

AIM: This work aimed to study the results of treatment of children with cystic formations of the pancreas using modern radiation diagnostic methods and minimally invasive surgical technologies.

MATERIALS AND METHODS: Analysis was conducted on the results of treatment of 66 patients consisting of 30 boys (45.5%) and 36 girls (54.5%) aged 6 months to 18 years (average age of 10.9 ± 5.2 years) with extraparenchymatous and intraparenchymatous pancreatic cysts.

RESULTS: Multispiral computed tomography (Se 90%, Sp 91%, and Ac 91%; p < 0.05) and magnetic resonance imaging (Se 96%, Sp 94%, Ac 95%; p < 0.05) are the most informative for the differential diagnosis of intra- and extraparenchymatous pancreatic cysts. For thin-walled extraparenchymatous cysts up to 6 cm in size, conservative therapy is effective in the early period of the disease. External (42.4%) and internal (51.3%) drainage of cysts can be performed when the existence of pancreatic pseudocysts is prolonged (more than 2 months). Indications for simultaneous longitudinal pancreaticoejunostomy may occur in 9.5% of patients. Excision of the pseudocyst with pancreatic resection may be required in 4.7% of cases. For intraparenchymatous cysts, 33.3% of cases require the enucleation of cystic formation, 25% require the distal splenoserving resection of the pancreas, 25% require the central resection of the pancreas with the imposition of distal pancreatoejunoanastomosis, and 12.5% require pylori-preserving pancreatoduodenal resection. Approximately 70.8% of surgical interventions on the pancreas in children can be performed by laparoscopic access with a conversion rate in 12.5% of cases.

CONCLUSIONS: The choice of surgical intervention in children with pancreatic cysts is determined by the etiology, cyst size, localization, connection with the main pancreatic duct, and degree of involvement of the parenchyma in the tumor process. Most operations on the pancreas may be performed using minimally invasive approaches.