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Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.ORCID-id: 0000-0002-1843-5673
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
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2023 (Engelska)Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 23, nr 6, s. 704-711Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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.

Ort, förlag, år, upplaga, sidor
Elsevier, 2023. Vol. 23, nr 6, s. 704-711
Nyckelord [en]
Accuracy, Complication, Intra-operative pancreatoscopy, Intraductal papillary mucinous neoplasia, Pancreatic surgery
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-211808DOI: 10.1016/j.pan.2023.06.006ISI: 001075021500001PubMedID: 37336668Scopus ID: 2-s2.0-85162859765OAI: oai:DiVA.org:umu-211808DiVA, id: diva2:1781895
Forskningsfinansiär
Cancerfonden, 19 0513 Fk 01 HStiftelsen Bengt Ihres fond för gastroenterologiCancer- och Allergifonden, 10384Cancerforskningsfonden i Norrland, AMP 21-1058Cancerforskningsfonden i Norrland, LP22-2301Ingabritt och Arne Lundbergs ForskningsstiftelseSvenska läkaresällskapet, SLS-961923Svenska läkaresällskapet, SLS-961919Tillgänglig från: 2023-07-11 Skapad: 2023-07-11 Senast uppdaterad: 2023-12-29Bibliografiskt granskad

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Arnelo, UrbanValente, RobertoScandavini, Chiara MariaHalimi, AsifSvensson, Johan

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