Intraoperative pancreatoscopy in pancreaticoduodenectomy for intraductal papillary mucinous neoplasms of the pancreas: Application to the laparoscopic approach

Hye yeon Yang, Incheon Kang, Ho Kyoung Hwang, Woo Jung Lee, Chang Moo Kang

Research output: Contribution to journalArticlepeer-review


Background: /Purpose: Owing to the characteristics of IPMNs, which have variable skipped lesions along the main pancreatic duct (MPD), determining the surgical margins is very difficult. This study aimed to investigate the efficacy and potential oncologic impact of intraoperative pancreatoscopy (IOP) compared to frozen section biopsy (FSB) in pancreaticoduodenectomy (PD) for pancreatic head IPMNs. Methods: Data of patients who underwent PD for IPMNs of the pancreas between October 2007 and May 2020 were retrospectively reviewed. IOP was performed in selected patients with IPMNs with inconclusive MPD involvement based on preoperative evaluations. Patients were divided into two groups, IOP group, FSB group. Clinicopathologic features and oncologic outcomes were compared between two groups. Results: 60 patients underwent PD (laparoscopic or robotic, 42; open, 18) for pancreatic head IPMNs. IOP was safely performed in 28 patients, including minimally invasive approach used in 21 patients (35%). IOP group had a significantly larger MPD size (9.15 ± 4.79 mm vs 6.43 ± 4.11 mm, p = 0.021). Based on IOP, the initial surgical plan could be changed in 5 patients (17.8%) for complete resection. Recurrence occurred in 2 patients in FSB group and 3 patients in IOP group during the follow-up period (33.2 months, [range, 3.5–131.4 months]). Overall disease-free survival rate did not significantly differ between two groups (p = 0.529). Conclusions: IOP can be safely performed in patients with pancreatic head IPMNs with MPD dilatation, even in the laparoscopic approach. Further studies evaluating the long-term oncologic effect of IOP for the management of IPMNs are required.

Original languageEnglish
Pages (from-to)166-173
Number of pages8
JournalAsian Journal of Surgery
Issue number1
Publication statusPublished - 2023 Jan

Bibliographical note

Funding Information:
This research was supported by a grant from the National Research Foundation ( NRF-2016K1A3A1A12953723 ), and the part of results were presented under the title, “Image-guided Laparoscopic Pancreaticoduodenectomy”, in video symposium 4: Laparoscopic and Robotic Surgery for Pancreatic Disease, the 30th Meeting of Japanese Society of the Hepato-Biliary-Pancreatic Surgery (JSHBPS) held in Yokohama on June 9, 2018. Moreover, the authors would like to thank Dong-Su Jang, MFA (medical illustrator), for his help with the illustrations.

Publisher Copyright:
© 2022 Asian Surgical Association and Taiwan Robotic Surgery Association

All Science Journal Classification (ASJC) codes

  • Surgery


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