Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases

Pontrelli, Arianna; Di Meo, Giovanna; Prete, Francesco Paolo; Panzera, Piercarmine; Luca, Giuseppe Massimiliano De; Calomino, Natale; Mita, Maria Teresa; De Simone, Belinda; Bisceglie, Michele; Miccoli, Monica Maria; Testini, Alfio Gianalberto; Covelli, Michele; Viola, Massimo G.; Marano, Luigi; Testini, Mario

doi:10.3390/diseases14050180

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Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases

by

Arianna Pontrelli

^1,†,

Giovanna Di Meo

^1,†

,

Francesco Paolo Prete

^1,*,

Piercarmine Panzera

^1,2,

Giuseppe Massimiliano De Luca

¹,

Natale Calomino

³

,

Maria Teresa Mita

⁴,

Belinda De Simone

⁵

,

Michele Bisceglie

¹,

Monica Maria Miccoli

¹,

Alfio Gianalberto Testini

⁶,

Michele Covelli

⁷,

Massimo G. Viola

⁴,

Luigi Marano

⁸

and

Mario Testini

¹

Department of Precision and Regenerative Medicine and Jonian Area (DiMePReJ), University of Bari “Aldo Moro”, P.zza Giulio Cesare 11, 70124 Bari, Italy

²

Department of Surgery, Di Venere Hospital, 70012 Bari, Italy

³

Kidney Transplant Unit, Department of Medicine Surgery and Neuroscience, University Hospital of Siena, 53100 Siena, Italy

⁴

Department of Surgery, Cardinale G. Panico Hospital, 73039 Tricase, Italy

⁵

Department of General and Emergency Surgery, Bufalini Hospital AUSL Romagna Cesena, 47521 Cesena, Italy

⁶

Department of Surgery, Sapienza University, 00161 Rome, Italy

⁷

Department of Medicine, LUM University, 70010 Casamassima, Italy

⁸

Department of Surgery, Academy of Applied Medical and Social Sciences—AMiSNS, 82-300 Elblag, Poland

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Diseases 2026, 14(5), 180; https://doi.org/10.3390/diseases14050180

Submission received: 10 April 2026 / Revised: 11 May 2026 / Accepted: 19 May 2026 / Published: 20 May 2026

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Abstract

Background: Solid pseudopapillary neoplasms of the pancreas (SPN-P) are rare, low-grade malignancies primarily affecting young women. While surgical resection is definitive, the optimal balance between oncological radicality and functional preservation remains a clinical challenge. This study evaluates tailored surgical strategies utilizing minimally invasive and parenchyma-preserving techniques. Patients and Methods: We conducted a multi-institutional retrospective analysis of SPN-P cases treated between March 2020 and May 2023. Out of 167 pancreatic resections, five paradigmatic cases were identified. We analyzed the decision-making process for preoperative staging (CT/MRI/EUS-FNB), surgical approach (open, laparoscopic, or robotic), and the implementation of parenchyma-preserving versus formal resections. Results: The cohort included four females and one male (mean age 40.6 years; range 13–73). Surgical approaches were tailored to tumor location and patient characteristics: two patients underwent pancreatoduodenectomy (one laparotomic, one laparoscopic), two underwent distal pancreatectomy (one robotic, one laparoscopic), and one pediatric patient underwent laparoscopic parenchyma-preserving central pancreatectomy. R0 resection was achieved in all cases. No Grade B/C postoperative pancreatic fistulas (POPF) or complications Clavien-Dindo ≥III occurred. At a mean follow-up (FU) of 38.4 months (range 20–58), the disease-free survival rate was 100%. One patient developed new-onset diabetes mellitus following distal pancreatectomy. Conclusions: A tailored surgical approach—integrating robotic, laparoscopic, and parenchyma-preserving techniques—may enable excellent oncological outcomes while minimizing morbidity. For SPN-P, the choice of procedure should prioritize the preservation of pancreatic function, particularly in young patients, without compromising surgical margins.

Keywords: solid pseudopapillary neoplasm of the pancreas; pancreatic neoplasm; pancreas surgery; pancreas

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MDPI and ACS Style

Pontrelli, A.; Di Meo, G.; Prete, F.P.; Panzera, P.; Luca, G.M.D.; Calomino, N.; Mita, M.T.; De Simone, B.; Bisceglie, M.; Miccoli, M.M.; et al. Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases. Diseases 2026, 14, 180. https://doi.org/10.3390/diseases14050180

AMA Style

Pontrelli A, Di Meo G, Prete FP, Panzera P, Luca GMD, Calomino N, Mita MT, De Simone B, Bisceglie M, Miccoli MM, et al. Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases. Diseases. 2026; 14(5):180. https://doi.org/10.3390/diseases14050180

Chicago/Turabian Style

Pontrelli, Arianna, Giovanna Di Meo, Francesco Paolo Prete, Piercarmine Panzera, Giuseppe Massimiliano De Luca, Natale Calomino, Maria Teresa Mita, Belinda De Simone, Michele Bisceglie, Monica Maria Miccoli, and et al. 2026. "Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases" Diseases 14, no. 5: 180. https://doi.org/10.3390/diseases14050180

APA Style

Pontrelli, A., Di Meo, G., Prete, F. P., Panzera, P., Luca, G. M. D., Calomino, N., Mita, M. T., De Simone, B., Bisceglie, M., Miccoli, M. M., Testini, A. G., Covelli, M., Viola, M. G., Marano, L., & Testini, M. (2026). Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases. Diseases, 14(5), 180. https://doi.org/10.3390/diseases14050180

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Tailored Surgical Treatment and Outcomes in Solid Pseudopapillary Neoplasms of the Pancreas: A Case Series of Five Consecutive Paradigmatic Cases

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