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. 2023 Aug 27;15(8):1799-1807.
doi: 10.4240/wjgs.v15.i8.1799.

Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review

Francis P Robertson  1 , Harry V M Spiers  2 , Wei Boon Lim  3 , Benjamin Loveday  4 , Keith Roberts  5 , Sanjay Pandanaboyana  3
Affiliations

Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review

Francis P Robertson et al. World J Gastrointest Surg. .

Abstract

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.

Keywords: Indocyanine green; Pancreatico-duodenectomy; Perfusion; Post pancreatectomy pancreatitis; Post-operative pancreatic fistula.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
PRISMA diagram of included studies.
See this image and copyright information in PMC

References

    1. Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, Gullerud RE, Donohue JH, Nagorney DM, Farnell MB. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–462. - PubMed
    1. de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, Porte RJ, Gouma DJ, Busch OR, Molenaar IQ Dutch Pancreatic Cancer Group. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–410. - PubMed
    1. Nymo LS, Kleive D, Waardal K, Bringeland EA, Søreide JA, Labori KJ, Mortensen KE, Søreide K, Lassen K. Centralizing a national pancreatoduodenectomy service: striking the right balance. BJS Open. 2020;4:904–913. - PMC - PubMed
    1. Søreide JA, Sandvik OM, Søreide K. Improving pancreas surgery over time: Performance factors related to transition of care and patient volume. Int J Surg. 2016;32:116–122. - PubMed
    1. Chen JY, Feng J, Wang XQ, Cai SW, Dong JH, Chen YL. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2015;21:5926–5933. - PMC - PubMed

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