Project overview
This retrospective–prospective study assessed the utility of intraoperative indocyanine green (ICG) fluorescence angiography in evaluating pancreatic stump perfusion during pancreaticoduodenectomy (PD) and its effect on reducing postoperative pancreatic fistula (POPF). Among 100 patients (50 in each group), those evaluated with ICG showed a lower, though not statistically significant, incidence of clinically relevant POPF (12%) compared to controls assessed by white light alone (26%, p=0.074). Intraoperative Doppler ultrasound consistently confirmed adequate blood flow even in ICG-defined hypoperfused stumps, and no stump revisions were performed. Multivariate analysis identified small pancreatic duct diameter and elevated drain amylase on postoperative day 3 as independent POPF predictors, while ICG findings were not significant. Although ICG imaging allowed real-time perfusion assessment, it did not independently correlate with reduced fistula rates. The findings suggest that POPF risk is multifactorial
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