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

doi:10.1016/j.asjsur.2022.03.003

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

Department of Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

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 language	English
Pages (from-to)	166-173
Number of pages	8
Journal	Asian Journal of Surgery
Volume	46
Issue number	1
DOIs	https://doi.org/10.1016/j.asjsur.2022.03.003
Publication status	Published - 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

Access to Document

10.1016/j.asjsur.2022.03.003

Cite this

@article{f0ce0f0255024629892b4887f4278eae,

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

abstract = "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.",

author = "Yang, {Hye yeon} and Incheon Kang and Hwang, {Ho Kyoung} and Lee, {Woo Jung} and Kang, {Chang Moo}",

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: {\textcopyright} 2022 Asian Surgical Association and Taiwan Robotic Surgery Association",

year = "2023",

month = jan,

doi = "10.1016/j.asjsur.2022.03.003",

language = "English",

volume = "46",

pages = "166--173",

journal = "Asian Journal of Surgery",

issn = "1015-9584",

publisher = "Elsevier Taiwan LLC",

number = "1",

}

TY - JOUR

T1 - Intraoperative pancreatoscopy in pancreaticoduodenectomy for intraductal papillary mucinous neoplasms of the pancreas

T2 - Application to the laparoscopic approach

AU - Yang, Hye yeon

AU - Kang, Incheon

AU - Hwang, Ho Kyoung

AU - Lee, Woo Jung

AU - Kang, Chang Moo

N1 - 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

PY - 2023/1

Y1 - 2023/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85126923374&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85126923374&partnerID=8YFLogxK

U2 - 10.1016/j.asjsur.2022.03.003

DO - 10.1016/j.asjsur.2022.03.003

M3 - Article

C2 - 35331591

AN - SCOPUS:85126923374

SN - 1015-9584

VL - 46

SP - 166

EP - 173

JO - Asian Journal of Surgery

JF - Asian Journal of Surgery

IS - 1

ER -

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

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this