Robertson FP, Spiers HVM, Lim WB, Loveday B, Roberts K, Pandanaboyana S. Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review. World J Gastrointest Surg 2023; 15(8): 1799-1807 [PMID: 37701689 DOI: 10.4240/wjgs.v15.i8.1799]
Corresponding Author of This Article
Francis P Robertson, BSc, FRCS (Ed), MBChB, PhD, Surgeon, Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, United Kingdom. francis.robertson.13@ucl.ac.uk
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1799-1807 Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1799
Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review
Francis P Robertson, Harry V M Spiers, Wei Boon Lim, Benjamin Loveday, Keith Roberts, Sanjay Pandanaboyana
Francis P Robertson, Wei Boon Lim, Sanjay Pandanaboyana, Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, United Kingdom
Harry V M Spiers, Department of HPB Surgery, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
Benjamin Loveday, Department of General Surgery, Royal Melbourne Hospital, Melbourne VIC 3050, Australia
Keith Roberts, Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham BG15 2GW, United Kingdom
Author contributions: Robertson FP, Spiers HVM, and Pandanaboyana S contributed to the manuscript preparation, study concept, and critical review; Loveday B and Roberts K were involved in the study concept and critical review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francis P Robertson, BSc, FRCS (Ed), MBChB, PhD, Surgeon, Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, United Kingdom. francis.robertson.13@ucl.ac.uk
Received: April 13, 2023 Peer-review started: April 13, 2023 First decision: May 19, 2023 Revised: May 23, 2023 Accepted: June 11, 2023 Article in press: June 11, 2023 Published online: August 27, 2023
ARTICLE HIGHLIGHTS
Research background
Despite centralization of pancreatic surgery, post-operative pancreatic fistula (POPF) rates remain high. The pathogenesis of the development of POPF remains poorly understood but there is some evidence to support poor perfusion of the pancreatic remanent in the development of this complications.
Research motivation
This research project was designed to identify the current published literature regarding the use of intra-operative perfusion assessment to help guide whether this can be incorporated into clinical use.
Research objectives
The aim of this study was to review the current evidence for assessment of perfusion of the pancreatic remanent prior to anastomosis in patients undergoing pancreatoduodenectomy.
Research methods
The medical literature was searched for studies assessing the perfusion of the pancreatic remanent intra-operatively. Studies were identified and data was extracted by 2 independent authors. A meta-analysis could not be performed and therefore a systematic scoping review was carried out.
Research results
The POPF rate in all studies was 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.
Research conclusions
This study has shown that indocyanine green can safely assess pancreatic perfusion intraoperatively. There was insufficient evidence to link poor perfusion of the pancreatic remanent with POPF and further well designed studies are required.
Research perspectives
The results of this study have not changed our clinical practice but ha highlights further areas of clinical research to make pancreatic surgery safer.
