Spleen-Preserving Distal Pancreatectomy after Chemotherapy for Initially Unresectable Pancreatoblastoma in a 3-Year-Old Girl, Paying Attention to Long-Term Change in Spleen Volume and Venous Collaterals

Background The long-term outcomes and validity of the Warshaw operation for childhood pancreatoblastoma remain uncertain. Case presentation Here we report a case of an initially unresectable pancreatoblastoma, curatively resected using spleen-preserving distal pancreatectomy with the Warshaw technique after effective chemotherapy in a 3- year-old girl. She was admitted with a large abdominal mass. The tumor arose in the body of pancreas and extended into the pancreatic head and tail, with involvement of the portal vein and splenic vessels and abutment to the common hepatic artery. Because total pancreatectomy and splenectomy with combined resection of the portal vein and common hepatic artery would have been needed to achieve complete resection, the patient initially received combination chemotherapy′ with cisplatin and 4-O-tetrahydropyranyl adriamycin for down-sizing. After completion of chemotherapy, the tumor showed a great reduction in size, allowing for complete resection and splenic preservation using the Warshaw operation for distal pancreatectomy. The postoperative course was uneventful, and the patient received adjuvant chemotherapy successfully. The patient has been disease-free for 39 months postoperatively, without any late complications such as gastric bleeding. Splenomegaly and the formation of perigastric varices and venous periportal collateral circulation was noted. Conclusion The Warshaw operation was a feasible and acceptable procedure for pancreatoblastoma in a pediatric patient. Aggressive chemotherapy followed by curative-intent pancreatectomy will be a promising treatment strategy for advanced pancreatoblastoma to preserve remnant pancreatic function and quality of life in children.


Yasuhiro Murata, Shugo Mizuno, Kohei Otake, Mikihiro Inoue, Hitoshi Honma, Hidemi Toyoda, Kazuo Fukutome, Keiichi Uchida, Yoshihiro Komada, Shuji Isaji

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