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.
Similar content being viewed by others
References
Singhi AD, Koay EJ, Chari ST, Maitra A (2019) Early detection of pancreatic cancer: opportunities and challenges. Gastroenterology 156(7):2024–2040
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):e5535
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
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):466–474
Marchegiani G, Fernàndez-del CC (2014) Is it safe to follow side branch IPMNs? Adv Surg 48(1):13–25
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):1678–1684
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):183–193
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):360–368
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):1045–1052
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):657–665
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):738–753
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):789–804
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 55:25–35
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):263–267
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):467–473
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 18:1100–1107
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):982–987
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
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
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):17–32
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 221:982–987
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):566–571
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):157–163
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):510–514
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):1891–1901
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):34–43
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):7431–7443
Funding
The authors have no funding to report.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Debora Ciprani, Hoda Amar, Adam Frampton, Oppong Kofi, Sanjay Pandanaboyana, and Somaiah Aroori have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ciprani, D., Frampton, A., Amar, H. et al. The role of intraoperative pancreatoscopy in the surgical management of intraductal papillary mucinous neoplasms of the pancreas: a systematic scoping review. Surg Endosc 37, 9043–9051 (2023). https://doi.org/10.1007/s00464-023-10518-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-023-10518-8