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The following is a summary of “Effect of warm and cold ischemia on pancreaticoduodenectomy specimen following robotic pancreaticoduodenectomy,” published in the November 2024 issue of Surgery by Abós et al.
Robotic pancreaticoduodenectomy (PD) has become increasingly popular for treating pancreatic head tumors and periampullary lesions, but the effect of specimen retrieval timing on diagnosis remains unclear.
Researchers conducted a retrospective study to evaluate histological changes associated with ischemia timing in specimens of PD.
They reviewed histopathology files for pancreatic specimens collected (January 2022 to March 2024). Warm ischemia time (WIT) and cold ischemia time (CIT) were assessed, evaluating ischemic damage in duodenal, pancreatic parenchyma, and pancreatic tumors. Statistical analysis (univariate and multivariate) was used to identify factors linked to moderate or severe ischemic changes.
The results showed 60 specimens, including 20 open PD, 17 robotic PD with cold ischemia, and 23 robotic PD. Median total WIT was 182 minutes (open PD 57 minutes vs. RPD 190 minutes vs. RPD-CI 198 minutes; P<0.001). Median CIT was 760 minutes (740–835) for specimens stored at 4°C. Univariate analysis showed longer intraoperative time, male gender, and cold ischemia were linked to pancreatic ischemic changes. Multivariate analysis identified cold ischemia as the only independent factor associated with moderate and severe ischemic changes in normal pancreatic tissue and tumors.
They concluded that prolonged ischemia, especially during cold storage, significantly degrades normal and tumor tissue, highlighting the need for minimizing ischemic time during surgery and improving specimen processing protocols.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02652-4
