Related Experiment Video
Updated: Jul 16, 2025
Normothermic Ex Vivo Pancreas Perfusion for the Preservation of Pancreas Allografts before Transplantation
Published on: July 27, 2022
Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review
Francis P Robertson1, Harry V M Spiers2, Wei Boon Lim3
1Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, United Kingdom. francis.robertson.13@ucl.ac.uk.
Insights
Post-operative pancreatic fistula (POPF) remains a significant risk after pancreaticoduodenectomy. Current evidence on intraoperative pancreas perfusion is limited and does not confirm a link between hypoperfusion and POPF, necessitating further research.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Imaging
Background:
- Post-operative pancreatic fistula (POPF) is a major complication following pancreaticoduodenectomy.
- High POPF rates persist despite known risk factors.
- Intraoperative pancreas stump hypoperfusion is a potential cause of anastomotic failure.
Purpose of the Study:
- To review and synthesize published literature on intraoperative pancreas perfusion assessment.
- To evaluate the correlation between pancreas stump perfusion and POPF development.
Main Methods:
- Systematic literature search conducted in November 2022.
- Extracted data included study characteristics, perfusion assessment methods, and POPF rates.
- Included 5 studies (2 prospective, 3 case reports) with 156 patients.
Main Results:
- Four studies used indocyanine green fluorescence angiography; one used visual inspection.
- Heterogeneity in POPF definitions was observed.
- POPF rate was 12%; hypoperfusion was present in 39% of POPF cases. POPF rates were 11% (no hypoperfusion) vs. 13% (hypoperfusion), indicating no clear link.
Conclusions:
- Current evidence on pancreas perfusion during pancreaticoduodenectomy is of low quality.
- A causative link between intraoperative hypoperfusion and POPF is not supported.
- High-quality prospective studies are needed to investigate this relationship.
Background:
Post-operative pancreatic fistula (POPF) is the primary cause of morbidity following pancreaticoduodenectomy. Rates of POPF have remained high despite well known risk factors. The theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained interest.
Aim:
To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with POPF.
Methods:
A systematic search of available literature was performed in November 2022. Data extracted included study characteristics, method of assessment of pancreas stump perfusion, POPF and other post-pancreatic surgery specific complications.
Results:
Five eligible studies comprised two prospective non-randomised studies and three case reports, total 156 patients. Four studies used indocyanine green fluorescence angiography to assess the pancreatic stump, with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic stump. There was significant heterogeneity in the definition of POPF. Studies had a combined POPF rate of 12%; intraoperative perfusion assessment revealed hypoperfusion was present in 39% of patients who developed POPF. The rate of POPF was 11% in patients with no evidence of hypoperfusion and 13% in those with evidence of hypoperfusion, suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut off. Significant variance in practice was seen in the pancreatic stump management once hypoperfusion was identified.
Conclusion:
The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor quality. It does not support a causative link between hypoperfusion and POPF. Further well-designed prospective studies are required to investigate this.
