Value of Intraoperative Pancreatoscopy in Patients Undergoing Resection for Main-Duct Intraductal Papillary Mucinous Neoplasm: Thirty-Day Follow-Up of a Prospective International Study

Objective: To report 30-day results from an ongoing 5-year study of intraoperative pancreatoscopy (IOP) in patients undergoing pancreatic surgery for main pancreatic duct (MPD) intraductal papillary mucinous neoplasm (IPMN). Background: IOP may detect skip lesions and objectify disease extent during surgery for IPMN with MPD involvement, but prospective multicenter data are lacking. Methods: Prospective international study including patients with IPMN and MPD diameter >5 mm on preoperative imaging, scheduled for surgery at 8 centers in 6 countries. Primary endpoint was the rate of detection by IOP of discontinuous (skip) lesions along the MPD. Secondary endpoints included IOP technical success, influence of IOP findings on surgical plan, and related serious adverse events (SAEs). Results: Among 100 patients undergoing IOP, skip lesions were documented in 13 (13.0%). IOP was technically successful in 91 (91.0%). In 41 patients (41.0%), IOP findings were reported by the surgeon to be impactful by confirming the absence of lesions in a dilated MPD and hence sparing parenchyma in 26 (26%), extending the initial resection in 12 (12%), or changing the type of partial pancreatectomy in 3 (3%). There were no IOP-related SAEs. Surgery-related SAEs were reported in 27 (27%) patients. Conclusions: IOP identified skip lesions in 13% of patients undergoing surgery for IPMN with MPD involvement. IOP influenced the surgical plan in 41% of patients. There were no IOP-related SAEs. Longer follow-up is ongoing. ClinicalTrials.gov number NCT03729453.