Shah's Gastro, Cancer & Robotic Surgery Centre · Ahmedabad & Gandhinagar
Solid pseudopapillary neoplasm surgeon in Ahmedabad · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
Last updated: 17-Oct-2026
Two questions come before any SPN operation. Is the lump truly an SPN? And what is the smallest operation that removes it whole?
Most people with an SPN are young women. Many hear about it after a scan done for something else. The report says “pancreatic tumour”, and the family fears the worst. Then a large operation is offered, sometimes with the spleen removed as well. This page is for that moment. A solid pseudopapillary neoplasm, also called a Frantz tumour, is not the pancreatic cancer you may have read about. It grows slowly and rarely spreads. When it is removed whole, that is usually the whole treatment. So the real risk is not doing too little. It is doing too much. Below, Dr Harsh Shah sets out how he checks the diagnosis, how he decides the size of the operation, who does it, and when a second look is worth taking before you sign.
An SPN has a typical look on scans and a typical pattern on the biopsy stains. Several other pancreas lumps can look similar at first.
| What is seen | What it tells the surgeon |
|---|---|
| A young woman, often in her teens to forties. | This is the usual patient. A mixed solid and fluid lump in her pancreas is an SPN until shown otherwise. |
| A lump with a clear outer wall and sharp edges. | SPNs are wrapped in a capsule. They push vessels aside rather than wrapping around them. |
| Mixed solid and fluid parts, with old bleeding inside. | This is the classic SPN look on a pancreas CT or MRI. Some have a rim of calcium. |
| CA 19-9 and CEA blood tests are normal. | A large lump with normal markers fits an SPN better than ordinary pancreatic cancer. |
| Nuclear beta-catenin on the biopsy stains. | This is the hallmark that confirms SPN. CD10, vimentin and progesterone receptor are usually positive too. |
| Chromogranin is negative. | This is what separates an SPN from a neuroendocrine tumour, its closest look-alike. |
A neuroendocrine tumour, a cystic tumour such as IPMN or MCN, and ordinary pancreatic cancer can all look like an SPN on a first scan. That matters, because the operations for them differ a lot. If the scan is not clear, an endoscopic ultrasound with a needle sample is done. It also helps when the sample would change the plan. A staging CT of the chest, abdomen and pelvis checks the liver, which is the usual place for the rare spread. Weight loss or feeling unwell is uncommon with an SPN. When present, it makes the doctor think again about the diagnosis. For a lump that is mostly fluid, the pancreatic cyst surgery decision page explains a different set of rules.
Every SPN is discussed at a tumour board before surgery. The main purpose is to stop an operation larger than the tumour needs.
Shah’s Gastro, Cancer & Robotic Surgery Centre. He trained in super-specialty surgical gastroenterology and holds two higher degrees in that field. He has 18 years of experience in GI and cancer surgery, including operations that remove part of the pancreas while keeping the rest. You see the same surgeon from the first visit to the last follow-up.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
A surgeon, a radiologist, a pathologist and a cancer physician look at the same scans and slides. The board must see every case where the diagnosis is unclear. It must also see every case with liver spread, and every young woman in whom keeping the spleen or more of the pancreas is being weighed. Then Dr Shah sits with you and the family. He explains the result in plain words, starting with the good news about the outlook. He performs the operation himself at Apollo Hospital, Bhat. Keyhole or robotic surgery suits many of these young, otherwise well patients. Some operations are better done open. The route is chosen for the operation you need, not the other way round. Ask who will be at the operating table or the robotic console on the day, and whether that holds if the date moves.
An SPN rarely spreads to lymph nodes and is usually removed for good in one operation. Removing extra organs adds lifelong harm and no benefit.
Ordinary pancreatic cancer is treated with a wide operation. The surgeon removes many lymph nodes and often the spleen. That logic does not fit an SPN. When an SPN is treated like ordinary cancer, a young woman can lose her spleen, much of her pancreas, or both. She then carries the effects for decades. So the aim is clear. Take the whole tumour with its capsule intact and a clear edge, and take as little else as possible. These are the things Dr Shah does not do for an SPN, and why.
| Not done routinely | Why not |
|---|---|
| Wide removal of lymph nodes, as for pancreatic cancer. | Spread to lymph nodes is rare in SPN. The extra surgery adds risk and gains nothing. |
| Removing the spleen along with a body or tail tumour. | The spleen is kept unless the tumour directly involves it. Losing it means a lifelong risk of serious infection. |
| Removing the whole pancreas. | Not for a tumour that a smaller operation can clear. Removing it all causes lifelong diabetes and digestive problems. |
| Giving up because of spots in the liver. | Liver spread from an SPN is still worth removing. People often live for many years after. |
The site of the tumour in the pancreas decides the operation. Each choice aims to keep as much pancreas, and the spleen, as safely possible.
| Where the SPN is | The operation Dr Shah prefers |
|---|---|
| Body or tail of the pancreas. | Spleen-preserving distal pancreatectomy. The left part of the pancreas is removed and the spleen stays. |
| Neck or the start of the body. | Central pancreatectomy. Only the middle part is removed, so both ends keep working. |
| Small, near the surface, away from the main duct. | Enucleation. The tumour is shelled out, but only if the main pancreatic duct can be kept safe. |
| Head or uncinate part. | Pancreatoduodenectomy, the Whipple operation, when a smaller operation cannot remove it whole. |
| Spots in the liver. | Removal of the liver spots, at the same time or later. This is not a wasted operation. |
A distal pancreatectomy for ordinary cancer usually takes the spleen too, as described on the distal pancreatectomy and splenectomy page. For an SPN, the spleen is kept by default. A tumour in the head may still need a Whipple, explained on the Whipple operation page. Before an enucleation or a central pancreatectomy, an ultrasound probe is used during the operation. It shows how close the tumour lies to the main duct. That finding can change the plan on the table, and you are told about this possibility beforehand.
The plan is set from the scans, but a few findings change it. Knowing them in advance means no surprise on the day.
| Finding | How it changes the plan |
|---|---|
| The tumour touches or grows into the spleen. | The spleen may have to come out. Vaccines are given before the operation, just in case. |
| The tumour lies against the main pancreatic duct. | Enucleation may not be safe. A distal or central pancreatectomy is done instead. |
| The tumour is in the head and cannot be shelled out. | A Whipple operation is needed to remove it whole. |
| The edge is close on the frozen section. | A little more tissue is taken while you are still asleep. |
| Spots are found in the liver. | They are planned for removal, at the same operation or a later one. |
| Sudden pain, bleeding into the tumour or rupture after an injury. | This is an emergency. The surgeon sees you the same day. |
| The diagnosis is still uncertain. | More tests or a board review come first, because the right operation depends on it. |
The spleen helps fight certain infections. Without it, a serious blood infection can develop fast, so it is kept whenever the tumour allows.
For a tumour in the body or tail, keeping the spleen is the default. Sometimes the tumour grows into it, and then it has to come out. Because that can happen, vaccines are given in advance whenever removal is possible, even when the plan is to keep it. If the spleen is removed, you receive the full lifelong infection-prevention programme before you go home. Any fever after that is treated with antibiotics at once. This programme is often forgotten when the spleen was removed as a side step of a pancreas operation. It is not forgotten here.
Smaller pancreas operations keep more of the gland, but the cut surface leaks juice more often. That is an accepted price for keeping function.
A pancreatic fistula is a leak of pancreatic juice from the cut edge. It is the commonest complication after any pancreas operation. It is more likely after enucleation and central pancreatectomy, because more pancreas is kept. A drain is placed, and the fluid is tested on the first day. Most leaks settle with the drain over days to weeks. A leak after one of these operations is expected and planned for. It is not a sign that the operation went wrong. In return, diabetes and digestive enzyme problems are much less likely than after a standard pancreatic cancer operation.
Every pancreas operation carries real risk. The size of that risk depends on the operation needed. Your own figures are given at consent.
General risks include bleeding that may need a transfusion, infection, clots in the legs or lungs, heart or breathing problems, and a problem with the anaesthetic. Pancreas-specific risks include a leak of pancreatic juice, a stomach that empties slowly for a while, bleeding after the operation, a collection of pus, and a return to theatre. There is also a small risk to life, which is higher for a Whipple than for a smaller resection. In the long run, diabetes or a need for enzyme capsules is possible, mostly after larger operations. If the spleen is removed, lifelong infection precautions follow. Dr Shah covers four points in person. They are the good outlook, said plainly and early; why a smaller operation is chosen; the higher leak risk that comes with it; and, where the spleen might be removed, what that means for life. For the general consent steps before pancreas surgery, see pancreatic surgery consent and second opinion.
| When | What happens |
|---|---|
| Day 1. | Drain fluid is tested for pancreatic juice. A leak is more likely after a shelling-out or middle-section operation. |
| Days 2 to 5. | Eating builds up step by step. The team watches for a leak and checks blood sugar, which is usually normal. |
| Before going home. | You eat well, walk, have pain controlled with tablets and have no fever. |
| Before going home. | Either there is no significant leak, or there is a written plan for the drain. |
| Before going home. | The final biopsy report is explained to you, with the outlook stated clearly. |
| Before going home, if the spleen was removed. | The full infection-prevention programme is started. |
An SPN rarely comes back, but when it does it can be late, often in the liver. So scans continue beyond five years.
| When | What is done |
|---|---|
| At three months. | A clinic review, the biopsy report and outlook discussed again, and checks on eating and blood sugar. |
| Every 6 to 12 months for five years. | A CT or MRI scan and a clinic review. |
| After five years. | Scans continue at longer gaps. They are more important if the capsule broke, the edge was not clear, or the report showed spread into vessels or nerves. |
| After a larger operation. | Blood sugar and enzyme capsules are checked. |
| If the spleen was removed. | Lifelong infection precautions and vaccines. |
| Planning a pregnancy. | There is no specific bar after recovery. The timing is discussed after a major pancreas operation. |
A second opinion helps most before the first operation. Take one if the plan looks like a pancreatic cancer operation for a tumour that is not.
| What you notice | Why it matters |
|---|---|
| The spleen is to be removed, but the tumour does not touch it. | For a body or tail SPN, the spleen is usually kept. |
| The whole pancreas is to be removed. | A smaller operation usually clears an SPN. |
| A wide lymph node removal is planned, as for pancreatic cancer. | Nodes are rarely involved in SPN. |
| You were told nothing can be done because of liver spots. | Removing liver spread from an SPN is usually worthwhile. |
| Chemotherapy was offered as the standard first treatment. | For an SPN that can be removed, surgery is the treatment. |
| The diagnosis rests on one scan, with no stains or board review. | A neuroendocrine tumour or a cystic tumour needs a different operation. |
| No one has explained the outlook in plain words. | This tumour behaves very differently from ordinary pancreatic cancer. |
| You were told you need no scans after the operation. | Late return, mostly in the liver, is known. Scans continue for years. |
A second opinion that agrees with your plan is not wasted. You go into the operation with no question left open. Bring every CT or MRI on a disc, the EUS and biopsy reports, the slides or blocks if you can get them, the CA 19-9 and CEA results, and a list of your medicines.
★★★★★
“We are very thankful to Dr. Harsh Shah for successfully performing the Whipple’s procedure. From the beginning, he explained everything clearly and gave us great confidence throughout the treatment. Today, we are happy to share that we received the discharge and are going home with a positive feeling. Thank you, Dr. Harsh Shah, for your expertise, care, and support. Highly recommended for GI surgery.”
— Desai Sonal, Google review
★★★★★
“My patient was having tumour in abdomen. Dr Harsh Shah did an operation called whipple’s operation. Today after 7 days of operation, we are being discharged from the hospital. We are happy with the services provided by Dr Harsh Shah & Apollo Hospital.”
— piyush aanjna, Google review
★★★★★
“Dr harsh shah is good doctor . Had done surgery for abdominal tumour .thank you so much.”
— narendra bhati, Google review
Reviews are reproduced exactly as written on Google. The first two describe a Whipple operation by Dr Harsh Shah. The third speaks about surgery for an abdominal tumour. None states the type of tumour, so none is presented as an SPN case.
The cost depends on the operation, the days in hospital and whether a leak needs a longer stay. A written estimate is given before admission.
Apollo Hospital, Bhat, works with the major insurers and cashless facilities. The insurance desk handles pre-authorisation. On admission, bring all scans on a disc or drive, all reports, your medicines with doses, the insurance card and an identity proof. If you have questions about your report before booking, call +91-63555-64601.
It is a tumour of low malignant potential. It grows slowly, rarely spreads, and complete removal is usually the whole treatment.
Not for an SPN that can be removed. Surgery is the treatment. For rare cases that cannot be removed, the tumour board decides case by case.
For a tumour in the body or tail, yes, in most cases. It is removed only if the tumour grows into it.
Often, yes. It suits many of these young, otherwise well patients. The route is chosen for the operation you need.
Removing the liver spots is still worthwhile. People with spread from an SPN often live for many years.
There is no specific bar after recovery. The timing is discussed with your surgeon after a major pancreas operation.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultations, review of reports and scans, second opinions and follow-up.
Google: Dr Harsh Shah · 4.89 · 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital — Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Operations, endoscopic ultrasound and hospital stay.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 · 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Families come to Ahmedabad from across Gujarat, including Gandhinagar, Mehsana, Banaskantha, Nadiad, Anand, Bhavnagar, Rajkot, Jamnagar and Kutch, and from southern Rajasthan and western Madhya Pradesh.
Told a pancreas lump may be an SPN, and offered an operation? The CT or MRI on a disc, any EUS or biopsy report, and blood test results can be sent ahead of your appointment, so the consultation starts with them already read. The plan is decided at the consultation, after examination. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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