Impact of Intraoperative Assessment of Pancreatic Perfusion Using Indocyanine Green on the Incidence of Complications after Pancreaticoduodenectomy

Objective: To evaluate the impact of intraoperative fluorescence angiography with indocyanine green (ICG) on pancreatic remnant perfusion and the incidence of postoperative complications (pancreatoenteric anastomotic leakage, postoperative pancreatitis, delayed gastric emptying) after pancreaticoduodenectomy, according to current international classifications (ISGPS and Clavien–Dindo). Material and methods: This study included 39 patients with resectable malignant neoplasms of the periampullary region (cT1–3N0M0) who underwent pancreaticoduodenectomy at the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 from 2023 to the present. Patients were divided into two groups: the study group (pancreaticoduodenectomy with intraoperative fluorescence angiography, n = 18) and the control group (conventional pancreaticoduodenectomy without fluorescence angiography, n = 21); the groups did not differ significantly in terms of age, sex, or ASA physical status. Intraoperative assessment of pancreatic remnant perfusion was performed using the SPY system (Stryker, USA) after intravenous administration of ICG in two stages: after resection and after completion of the pancreatoenteric anastomosis. Results: In the study group, adequate pancreatic remnant perfusion without signs of hypoperfusion was observed in 83.3% of patients, while in 16.7%, additional resection of poorly perfused areas was performed, followed by restoration of uniform fluorescence. The incidence of pancreatoenteric anastomotic leakage was 11.1% in the study group and 28.6% in the control group ( p = 0.048); post-operative pancreatitis was observed only in the control group (19.0%), whereas the incidence of delayed gastric emptying was lower with ICG use (11.1% vs 19.0%, p = 0.667). In the study group, grade I–II complications according to Clavien–Dindo classification predominated, while in the control group grade III or higher complications were more frequent; the duration of abdominal drainage (6.2 ± 1.5 vs 8.9 ± 2.3 days, p < 0.05) and hospital stay (14.7 ± 3.1 vs 18.5 ± 4.2 days, p < 0.05) were significantly shorter with the use of fluorescence angiography. No complications related to ICG administration were observed. Conclusion: Intraoperative fluorescence angiography with ICG enables objective assessment of pancreatic remnant tissue perfusion, identification of areas of focal hypoperfusion, and adjustment of the resection line, which is associated with a reduced incidence and severity of pancreatoenteric anastomotic leakage.