title: Impact of Intraoperative Pancreatoscopy with Intraductal Biopsies on Surgical Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas.
abstract: BACKGROUND
  Because of its known malignant potential, precise histologic diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN) during intraoperative pancreatoscopy (IOP) is essential for complete surgical resection. The impact of IOP on perioperative IPMN patient management was reviewed over 20 years of practice at Cliniques universitaires Saint-Luc, Brussels, Belgium.
  
  
  METHODS
  Among 86 IPMN patients treated by pancreatectomy between 1991 and 2013, 21 patients had a dilated main pancreatic duct enabling IOP and were retrospectively reviewed. The IOP was performed using an ultrathin flexible endoscope and biopsy forceps, and specimens of all suspicious lesions underwent frozen section examination.
  
  
  RESULTS
  Complete IOP with intraductal biopsies was easily and safely performed in 21 patients, revealing 8 occult IPMN lesions. In 5 cases (23.8%), initially planned surgical resection was modified secondary to IOP: 3 for carcinoma in situ and 2 for invasive carcinoma. The postoperative morbidity rate at 3 months was 25.0% (5 of 20); 1 patient died from septic shock postoperatively and was excluded. Median follow-up was 93 months (range 13 to 248 months). Nineteen of 21 patients were still alive and free of disease at last follow-up (90.5%); there was 1 patient with invasive carcinoma at initial pathology (pT3 N1) who died of pulmonary recurrence 21 months after surgery.
  
  
  CONCLUSIONS
  Intraoperative pancreatoscopy of the main pancreatic duct combined with intraductal biopsies plays a significant role in the surgical management of IPMN patients and should be used in all patients presenting a sufficiently dilated main pancreatic duct.
authors: Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Julie
authors: J
authors: Navez
authors: Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Catherine
authors: C
authors: Hubert
authors: Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Jean-François
authors: JF
authors: Gigot
authors: Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Ivan
authors: I
authors: Borbath
authors: Department of Imaging study, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Laurence
authors: L
authors: Annet
authors: Department of Pathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Christine
authors: C
authors: Sempoux
authors: Cancer Center Institute Roi Albert II, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Valérie
authors: V
authors: Lannoy
authors: Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
authors: Pierre
authors: P
authors: Deprez
authors: Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. Electronic address: nicolas.jabbour@uclouvain.be.
authors: Nicolas
authors: N
authors: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies