Yang Hye Yeon, Kang Incheon, Hwang Ho Kyoung, Lee Woo Jung, Kang Chang Moo
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea.
Division of HBP and Transplantation Surgery, Department of Surgery, CHA Bundang Medical Center, CHA University, South Korea.
Asian J Surg. 2023 Jan;46(1):166-173. doi: 10.1016/j.asjsur.2022.03.003. Epub 2022 Mar 21.
/Purpose: Owing to the characteristics of IPMNs, which have variable skipped lesions along the main pancreatic duct (MPD), determining the surgical margins is very difficult. This study aimed to investigate the efficacy and potential oncologic impact of intraoperative pancreatoscopy (IOP) compared to frozen section biopsy (FSB) in pancreaticoduodenectomy (PD) for pancreatic head IPMNs.
Data of patients who underwent PD for IPMNs of the pancreas between October 2007 and May 2020 were retrospectively reviewed. IOP was performed in selected patients with IPMNs with inconclusive MPD involvement based on preoperative evaluations. Patients were divided into two groups, IOP group, FSB group. Clinicopathologic features and oncologic outcomes were compared between two groups.
60 patients underwent PD (laparoscopic or robotic, 42; open, 18) for pancreatic head IPMNs. IOP was safely performed in 28 patients, including minimally invasive approach used in 21 patients (35%). IOP group had a significantly larger MPD size (9.15 ± 4.79 mm vs 6.43 ± 4.11 mm, p = 0.021). Based on IOP, the initial surgical plan could be changed in 5 patients (17.8%) for complete resection. Recurrence occurred in 2 patients in FSB group and 3 patients in IOP group during the follow-up period (33.2 months, [range, 3.5-131.4 months]). Overall disease-free survival rate did not significantly differ between two groups (p = 0.529).
IOP can be safely performed in patients with pancreatic head IPMNs with MPD dilatation, even in the laparoscopic approach. Further studies evaluating the long-term oncologic effect of IOP for the management of IPMNs are required.
/目的：由于胰腺导管内乳头状黏液性肿瘤（IPMN）具有沿主胰管（MPD）存在可变的跳跃性病变的特点，确定手术切缘非常困难。本研究旨在探讨术中胰管镜检查（IOP）与冰冻切片活检（FSB）相比，在胰头IPMN的胰十二指肠切除术（PD）中的疗效及潜在的肿瘤学影响。
回顾性分析2007年10月至2020年5月间因胰腺IPMN接受PD手术的患者资料。根据术前评估，对MPD受累情况不明确的IPMN患者进行选择性IOP检查。患者分为两组，即IOP组和FSB组。比较两组的临床病理特征和肿瘤学结局。
60例患者因胰头IPMN接受了PD手术（腹腔镜或机器人手术42例，开放手术18例）。28例患者安全地接受了IOP检查，其中21例患者采用了微创方法（35%）。IOP组的MPD直径明显更大（9.15±4.79mm对6.43±4.11mm，p=0.021）。基于IOP检查，5例患者（17.8%）的初始手术计划因需完整切除而改变。随访期间（33.2个月，[范围，3.5 - 131.4个月]），FSB组有2例患者复发，IOP组有3例患者复发。两组的总体无病生存率无显著差异（p=0.529）。
即使在腹腔镜手术中，胰头IPMN且MPD扩张的患者也可安全地进行IOP检查。需要进一步研究评估IOP在IPMN治疗中的长期肿瘤学效果。
