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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2023

31-10-2023 | Pancreatoduodenostomy | Review Article

The role of intraoperative pancreatoscopy in the surgical management of intraductal papillary mucinous neoplasms of the pancreas: a systematic scoping review

Authors: Debora Ciprani, Adam Frampton, Hoda Amar, Kofi Oppong, Sanjay Pandanaboyana, Somaiah Aroori

Published in: Surgical Endoscopy | Issue 12/2023

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Abstract

Background

The type and the extent of surgery is still debatable for intraductal papillary mucinous neoplasm (IPMN). Intraoperative pancreatoscopy (IOP) allows the visualization of the main pancreatic duct (MPD) in its entire length and could help determine the extent of MPD involvement and the type and extent of pancreatic resection. However, current guidelines do not advise its routine use as there is a lack of evidence supporting its safety and feasibility. The present study aims to perform a scoping review of published evidence on the safety and feasibility of IOP in IPMN surgical management.

Methods

We systematically searched PubMed, Cochrane, Medline and EMbase to identify studies reporting the use of IOP in IPMN surgical management. The research was completed in June 2023. Data extracted included patient selection criteria, demographics, safety of the procedure, intraoperative findings, impact on surgical strategy, histology results and postoperative outcomes.

Results

Four retrospective and one prospective study were included in this scoping review. A total of 142 patients had IOP. The selection criteria for inclusion were heterogenous, with one out of five studies including branch duct (BD), main duct (MD) and mixed type IPMN. Indications for IOP and surgical resection were only reported in two studies. A median of seven outcomes (range 5–8) was described, including the type of surgical resection, additional lesions and change of surgical plan, and complications after IOP. IOP showed additional lesions in 48 patients (34%) and a change of surgical plan in 48(34%). No IOP-related complications were reported.

Conclusions

This scoping review suggests IOP is safe and identifies additional lesions impacting the surgical strategy for IPMN. However, the included studies were small and heterogeneous regarding IPMN definition and indications for surgery and IOP. There is a need for a large multi-centre prospective study to determine the role of IOP and its impact on surgical strategy for IPMN.
Appendix
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Literature
1.
Singhi AD, Koay EJ, Chari ST, Maitra A (2019) Early detection of pancreatic cancer: opportunities and challenges. Gastroenterology 156(7):2024–2040CrossRef
2.
Chang YR, Park JK, Jang J, Kwon W, Yoon JH, Kim S (2016) Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals. Medicine (Baltimore) 95(51):e5535CrossRefPubMed
3.
Sahora K, Castillo CFD, Dong F, Marchegiani G, Thayer SP, Ferrone CR et al (2014) Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: Implications of minimal involvement of the main pancreatic duct. Surgery (United States) 156(3):611–621
4.
Sahora K, Mino-Kenudson M, Brugge W, Thayer SP, Ferrone CR, Sahani D et al (2013) Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg 258(3):466–474CrossRefPubMed
5.
Marchegiani G, Fernàndez-del CC (2014) Is it safe to follow side branch IPMNs? Adv Surg 48(1):13–25CrossRefPubMed
6.
Marchegiani G, Andrianello S, Pollini T, Caravati A, Biancotto M, Secchettin E et al (2019) “Trivial” cysts redefine the risk of cancer in presumed branch-duct intraductal papillary mucinous neoplasms of the pancreas. Am J Gastroenterol 114(10):1678–1684CrossRefPubMed
7.
Liu H, Cui Y, Shao J, Shao Z, Su F, Li Y (2021) The diagnostic role of CT, MRI/MRCP, PET/CT, EUS and DWI in the differentiation of benign and malignant IPMN: a meta-analysis. Clin Imaging 72(41):183–193CrossRefPubMed
8.
Tamura K, Ohtsuka T, Ideno N, Aso T, Shindo K, Aishima S et al (2014) Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review. Ann Surg 259(2):360–368CrossRefPubMed
9.
Watanabe Y, Nishihara K, Niina Y, Abe Y, Amaike T, Kibe S et al (2016) Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review. Surg Today 46(9):1045–1052CrossRefPubMed
10.
He J, Cameron JL, Ahuja N, Makary MA, Hirose K, Choti MA et al (2013) Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 216(4):657–665CrossRefPubMedPubMedCentral
11.
Tanaka M, Fernández-del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T et al (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17(5):738–753CrossRefPubMed
12.
Del Chiaro M, Besselink MG, Scholten L, Bruno MJ, Cahen DL, Gress TM et al (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67(5):789–804CrossRef
13.
Jong DM, Stassen PMC, Koerkamp BG, Ellrichmann M, Karagyozov PI (2023) The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis. Endoscopy 55:25–35CrossRefPubMed
14.
Kaneko T, Nakao A, Nomoto S, Furukawa T, Hirooka Y, Nakashima N et al (1998) Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 133(3):263–267CrossRefPubMed
15.
Tricco AC, Lillie E, Zarin W, Brien KKO, Colquhoun H, Levac D et al (2018) Research and reporting methods PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467–473CrossRef
16.
Pucci MJ, Johnson CM, Viren P, Siddiqui AA, Lopez K, Winter JM et al (2014) Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons. J Gastrointest Surg 18:1100–1107CrossRefPubMed
17.
Navez J, Hubert C, Gigot JF, Borbath I, Annet L, Sempoux C et al (2015) Impact of intraoperative pancreatoscopy with intraductal biopsies on surgical management of intraductal papillary mucinous neoplasm of the pancreas. J Am Coll Surg 221(5):982–987CrossRefPubMed
18.
Yeon YH, Kang I, Hwang HK, Lee WJ, Kang CM (2022) Intraoperative pancreatoscopy in pancreaticoduodenectomy for intraductal papillary mucinous neoplasms of the pancreas: application to the laparoscopic approach. Asian J Surg 46(1):166–173
19.
Arnelo U, Valente R, Scandavini CM, Halimi A, Mucelli RMP, Rangelova E et al (2023) Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study. Pancreatology S1424–3903(23):00183–00187
20.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6(1–2):17–32CrossRefPubMed
21.
Navez J, Hubert C (2015) Impact of intraoperative pancreatoscopy with intraductal biopsies on surgical management of intraductal papillary mucinous neoplasm of the pancreas. J Am Coll Surg 221:982–987CrossRefPubMed
22.
Ohtsuka T, Gotoh Y, Nakashima Y, Okayama Y, Nakamura S, Morita M et al (2018) Role of SpyGlass-DStm in the preoperative assessment of pancreatic intraductal papillary mucinous neoplasm involving the main pancreatic duct. Pancreatology 18(5):566–571CrossRefPubMed
23.
Attiyeh MA, Fernández-Del Castillo C, Al Efishat M, Eaton AA, Gönen M, Batts R et al (2018) Development and validation of a multi-institutional preoperative nomogram for predicting grade of dysplasia in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Ann Surg 267(1):157–163CrossRefPubMed
24.
Arnelo U, Siiki A, Swahn F, Segersvärd R, Enochsson L, Del Chiaro M et al (2014) Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN). Pancreatology 14(6):510–514CrossRefPubMed
25.
Kurihara T, Yasuda I, Isayama H, Tsuyuguchi T, Yamaguchi T, Kawabe K et al (2016) Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases: prospective multicenter study in Japan. World J Gastroenterol 22(5):1891–1901CrossRefPubMedPubMedCentral
26.
Hara T, Yamaguchi T, Ishihara T, Tsuyuguchi T, Kondo F, Kato K et al (2002) Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 122(1):34–43CrossRefPubMed
27.
Vehviläinen S, Fagerström N, Valente R, Seppänen H, Udd M, Lindström O et al (2022) Single-operator peroral pancreatoscopy in the preoperative diagnostics of suspected main duct intraductal papillary mucinous neoplasms: efficacy and novel insights on complications. Surg Endosc 36(10):7431–7443CrossRefPubMedPubMedCentral
Metadata
Title
The role of intraoperative pancreatoscopy in the surgical management of intraductal papillary mucinous neoplasms of the pancreas: a systematic scoping review
Authors
Debora Ciprani
Adam Frampton
Hoda Amar
Kofi Oppong
Sanjay Pandanaboyana
Somaiah Aroori
Publication date
31-10-2023
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10518-8

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