Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1799
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
Processing time: 133 Days and 12.4 Hours
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.
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.
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.
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.
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.
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.
The results of this study have not changed our clinical practice but ha highlights further areas of clinical research to make pancreatic surgery safer.