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

Table 1 Study characteristics of included articles

Ref.	Country of origin	Study design	Study population	Disease process
Strasberg et al[25], 2002	United States	Prospective cohort	Patients undergoing pancreatoduodenectomy with pancreatojejunostomy at a single institution 1996 to 2000	Malignant (n = 107): Pancreatic cancer (n = 48); ampullary cancer (n = 28); NET (n = 6); villous adenoma (n = 6); MCN (n = 6); bile duct cancer (n = 5); duodenal adenocarcinoma (n = 3); serous cystadenoma (n = 3); IPMN (n = 1); GIST (n = 1). Benign (chronic pancreatitis, n = 16)
Subar et al[24], 2015	France	Case report	One patient undergoing laparoscopic pancreatoduodenectomy with pancreatojejunostomy	Malignant (ampullary adenocarcinoma)
Rho et al[23], 2019	Korea	Case report	One patient undergoing laparoscopic pancreatoduodenectomy with pancreatojejunostomy	Malignant (distal cholangiocarcinoma)
Doussot et al[27], 2021	France	Prospective cohort	Consecutive patients undergoing open pancreatoduodenectomy with pancreatojejunostomy at a single institution from January 2020 to November 2020	Malignant (n = 30, periampullary malignancies)
Iguchi et al[26], 2021	Japan	Case report	One patient undergoing open middle segment-preserving pancreatectomy with pancreatojejunostomy	Malignant (pancreatic ductal adenocarcinoma in head of pancreas with IPMN in the tail of pancreas)

NET: Neuro endocrine tumour; MCN: Mucinous cystic neoplasm; IPMN: Intraductal papillary mucinous neoplasm; GIST: Gastrointestinal stromal tumour.

Table 2 Intraoperative perfusion assessment and management of hypoperfusion

Ref.	Measurement of hypoperfusion	Description of technique	Total number of patients	Number with hypoperfusion	Management of hypoperfusion
Strasberg et al[25]	Visual assessment by surgeon	Blood supply was considered adequate when pulsatile arterial bleeding was present both superior and inferior to the pancreatic duct on the cut surface of the pancreas. The bleeding was required to be brisk (of a level that required sutures to stop the bleeding). If there was no bleeding, or if the bleeding points were of an oozing type that could be controlled without sutures, the blood supply was considered inadequate	123	47	Further 1.5-2 cm of pancreas transected
Subar et al[24]	ICG	Peripheral injection of 2 mL (0.5 mg) of Infracyanine™ (concentration was 0.25 mg/mL). The infrared camera is then focused on the transected margin of the pancreas	1	1	Ischaemic segment resected further
Rho et al[23]	ICG	ICG in jVR 25.0 mg (Doingin-dang Pharmaceutical Company, Siheung, Gyeonggi, Republic of Korea) given via peripheral IV injection at least three minutes before confirmation of pancreatic perfusion. Waited at least 30 s to determine perfusion with IMAGE1 STM H3-LINK and D-LIGHT P system (KARL STORZ SE & Co.KR, Tuttlingen, Germany)	1	1	Reinforcement using surgical glue (Greenplast QVR 2 mL, GREEN CROSS Corp., Yongin, Gyeonggi, Republic of Korea)
Doussot et al[27]	ICG	Pancreas stump was inspected after ICG IV injection (INFRACYANINE 0.1 mg/kg; Serb, Paris, France) using a microscope with near-infrared light source allowing real-time ICG perfusion assessment with near-infrared light images	30	6	One patient had further 3 cm pancreatic stump resection
Iguchi et al[26]	ICG	10 mg of ICG was administered IV. The presence of fluorescence in the pancreatic remnant was definitively confirmed with a fluorescence camera	1	0	NA

ICG: Indocyanine green; IV: Intravenous; NA: Not available.

Table 3 Post-operative outcomes

Ref.	Total number developing POPF	Number hypoperfused developing POPF	Delayed gastric emptying	Post-pancreatectomy haemorrhage	90-d mortality
Strasberg et al[25]	4	2 (1.6)	11	0	1
Subar et al[24]	0	0 (0)	0	0	NR
Rho et al[23]	1	1 grade A	1 grade B	0	NR
Doussot et al[27]	12 (9 grade A and 3 grade B)	3 (1 grade A and 2 grade B)	5 (17)	2 (1 grade B and 1 grade C)	0
Iguchi et al[26]	1 grade B	1 grade B	0	0	Alive at 2 mo

Post-operative pancreas fistula, delayed gastric emptying and post-pancreatectomy haemorrhage graded according to the International Study Group of Pancreatic Surgery definitions, except Strasberg, which was published prior to these definitions. POPF: Post-operative pancreatic fistula; NR: Not reported.