Pancreaticoduodenectomy is the treatment of choice for adult periampullary lesions. However there has been no studies on the clinical outcomes of pancreaticoduodenectomy in children. To evaluate the clinical outcomes, records of 13 patients who underwent pancreaticoduodenectomy, from 1989 to 2009, at Seoul National University Children's Hospital were reviewed. Mean follow up period was 83 (2-204) months, the male to female ratio was 1:3.3, and the mean age was 11 (2-14) years. Ten patients underwent PPPD and 3 patients had Whipple's operation. The postoperative diagnosis included solid pseudopapillary tumor (9), cavernous hemangioma (1), pseudocyst (1), benign cyst (1), pancreatic disruption (1). Two patients developed postoperative adhesive ileus and among them one patient required operative intervention. Four patients required pancreatin supplementation due to steatorrhea and other gastrointestinal symptoms. There were no postoperative mortality during the follow up period and no evidence of recurrence in SPT patients. This study demonstrates that the pancreaticoduodenectomy procedure in children is not only feasible but also safe, with no mortality and an acceptable complication rate.

Solid pseudopapillary tumor (SPT) of the pancreas occurs most frequently in the second or third decades of life, and is prevalent in females. Unlike other pancreatic malignancy, SPT usually has a low malignancy potential. This study reviews our clinical experience and surgical treatment of pancreatic SPT. Admission records and follow-up data were analyzed retrospectively for the period between January 1996 and January 2003. Five patients with a pancreatic mass were operated upon and SPT was confirmed by pathology in each case. The male to female ratio was 1 : 4. The median age was 13.8 years. Findings were vague upper abdominal pain (n=5, 100 %) and an abdominal palpable mass (n=3, 60 %). The median tumor diameter was 6.8cm and the locations were 2 in the pancreatic head (40 %) and 3 in the pancreatic tail (60 %). Extra-pancreatic invasion or distant metastasis was not found at the initial operation in all five cases. A pyloruspreserving pancreaticoduodenectomy (n=1) and a mass enucleation (n=1) were performed in two patients of pancreatic head tumors. For three cases of tumors in pancreatic tail, distal pancreatectomy (n=2) and combined distal pancreatectomy and splenectomy (n=1) were performed. The median follow-up period was 60 months(12-117month). During the follow-up period, there was no local recurrence, nor distant metastasis. Postoperative adjuvant chemotherapy or radiotherapy was not carried out. All five children were alive during the follow up period without any evidence of disease relapse. SPT of the pancreas in childhood has good prognosis and surgical resection of the tumor is usually curative.