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Value of Intraoperative Pancreatoscopy in Patients Undergoing Resection for Main-Duct Intraductal Papillary Mucinous
Urban Arnelo1, Roberto Valente1,2, Marc G Besselink3,4
1From the Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
Objective:
To report 30-day results from an ongoing 5-year study of intraoperative pancreatoscopy (IOP) in patients undergoing pancreatic surgery for main pancreatic duct (MPD) intraductal papillary mucinous neoplasm (IPMN).
Background:
IOP may detect skip lesions and objectify disease extent during surgery for IPMN with MPD involvement, but prospective multicenter data are lacking.
Methods:
Prospective international study including patients with IPMN and MPD diameter >5 mm on preoperative imaging, scheduled for surgery at 8 centers in 6 countries. Primary endpoint was the rate of detection by IOP of discontinuous (skip) lesions along the MPD. Secondary endpoints included IOP technical success, influence of IOP findings on surgical plan, and related serious adverse events (SAEs).
Results:
Among 100 patients undergoing IOP, skip lesions were documented in 13 (13.0%). IOP was technically successful in 91 (91.0%). In 41 patients (41.0%), IOP findings were reported by the surgeon to be impactful by confirming the absence of lesions in a dilated MPD and hence sparing parenchyma in 26 (26%), extending the initial resection in 12 (12%), or changing the type of partial pancreatectomy in 3 (3%). There were no IOP-related SAEs. Surgery-related SAEs were reported in 27 (27%) patients.
Conclusions:
IOP identified skip lesions in 13% of patients undergoing surgery for IPMN with MPD involvement. IOP influenced the surgical plan in 41% of patients. There were no IOP-related SAEs. Longer follow-up is ongoing. ClinicalTrials.gov number NCT03729453.
Insights
Intraoperative pancreatoscopy (IOP) detected skip lesions in 13% of patients with main pancreatic duct (MPD) intraductal papillary mucinous neoplasm (IPMN). IOP findings influenced surgical plans in 41% of cases, with no IOP-related adverse events.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Medical Imaging
Background:
- Intraductal papillary mucinous neoplasm (IPMN) of the main pancreatic duct (MPD) requires careful surgical management.
- Intraoperative pancreatoscopy (IOP) may aid in assessing disease extent during surgery for IPMN.
- Prospective data on the utility and safety of IOP for IPMN are limited.
Purpose of the Study:
- To evaluate the 30-day outcomes of intraoperative pancreatoscopy (IOP) in patients undergoing pancreatic surgery for main pancreatic duct (MPD) intraductal papillary mucinous neoplasm (IPMN).
- To assess the ability of IOP to detect skip lesions and influence surgical decision-making.
- To determine the technical success and safety of IOP in this patient population.
Main Methods:
- A prospective international multicenter study involving 100 patients with IPMN and MPD diameter >5 mm.
- Patients underwent IOP during pancreatic surgery at 8 centers across 6 countries.
- Primary endpoint: detection rate of discontinuous (skip) lesions by IOP. Secondary endpoints: technical success, impact on surgical plan, and serious adverse events (SAEs).
Main Results:
- Skip lesions were detected in 13.0% of patients by IOP.
- IOP was technically successful in 91.0% of cases.
- IOP findings influenced the surgical plan in 41.0% of patients, leading to parenchyma sparing in 26%, extended resection in 12%, or altered resection type in 3%.
Conclusions:
- Intraoperative pancreatoscopy is effective in identifying skip lesions in patients with MPD-IPMN.
- IOP significantly impacts surgical planning, potentially optimizing resection strategies.
- IOP demonstrated a favorable safety profile with no IOP-related serious adverse events observed.
