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. 2023 Sep;23(6):704-711.
doi: 10.1016/j.pan.2023.06.006. Epub 2023 Jun 12.

Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: A pilot study

Urban Arnelo  1 , Roberto Valente  2 , Chiara Maria Scandavini  3 , Asif Halimi  4 , Raffaella M Pozzi Mucelli  5 , Elena Rangelova  6 , Johan Svensson  7 , Richard D Schulick  8 , Robert J Torphy  8 , Niklas Fagerström  9 , Carlos Fernández Moro  10 , Miroslav Vujasinovic  9 , Johannes Matthias Löhr  11 , Marco Del Chiaro  8
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Free article

Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: A pilot study

Urban Arnelo et al. Pancreatology. 2023 Sep.
Free article

Abstract

Objectives: Intraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs.

Methods: This is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis.

Results: In total, 46 patients, 48% females, mean age (range) 67 years (45-82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas.

Conclusion: Intraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.

Keywords: Accuracy; Complication; Intra-operative pancreatoscopy; Intraductal papillary mucinous neoplasia; Pancreatic surgery.

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Conflict of interest statement

Declaration of competing interest Disclosures are the following: Dr. Del Chiaro received a research grant from Haemonetics, Inc and is co-PI of a Boston Scientific sponsored study on the use of intra-operative pancreatoscopy in IPMN's patients. Dr. Arnelo is co-PI of a Boston Scientific sponsored study on the use of intra-operative pancreatoscopy in IPMN's patients. Dr. Arnelo is consultant to Boston Scientific and Ambu. Dr. Valente is consultant for Boston Scientific. Dr. Vujasinovic has received lecture fees from Abbot and Viatris and he is consultant to Abbot. Dr. Rangelova has received research grants from ESGAR, Viatris, Västra Götalands res grants and Bengt Ihre.