Intraoperative Ultrasonography in Pancreatic Surgery: Staging and Resection Guidance

Abstract

Background: Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided. Materials and Methods: In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors — in 46 (60.5%) patients, for body/tail pancreatic tumors — in 20 (26.3%) patients, in 10 (13.2%) patients — for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy — in 14 (18.4%) patients. Results: IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases — 11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply. Conclusions: IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course.

The First Case Report of Robotic Multivisceral Resection for Synchronous Liver Metastasis from Pancreatic Neuroendocrine Tumor: A Case Report and Literature Review

“…Also intraoperative Doppler ultrasound was used to identify the boundaries of pancreatic mass and to determine the transection line of the pancreas, as well as to identify the splenic vessels. 46,47 We herein present the first case of totally robotic distal pancreatectomy, left hemihepatectomy and splenectomy for PNET with no severe perioperative comorbidity and optimal oncologic outcomes. As the tumor was stable and localized in just pancreas and liver, she was offered surgery with both curative and cytoreductive intent.…”

Intraoperative Ultrasound During Surgical Exploration in Patients with Pancreatic Cancer and Vascular Involvement (ULTRAPANC): A Prospective Multicenter Study

“…Previous studies on IOUS in pancreatic cancer have mainly focused on the detection of metastases, rather than the evaluation of vascular involvement. [21][22][23][24] A previous prospective monocenter study by our group suggested that IOUS could be useful, as it downstaged the local resectability status in one-third of 38 patients with LAPC after induction chemotherapy. 14 Another monocenter study by our group included 31 patients with pancreatic ductal adenocarcinoma (PDAC), or periampullary cancer, and indicated more accurate assessment of vascular involvement by IOUS, compared with conventional imaging modalities.…”

Usefulness of indocyanine green‐fluorescence imaging for real‐time visualization of pancreas neuroendocrine tumor and cystic neoplasm

“…Visual inspection, palpation, and IOUS are intraoperative modalities to identify pancreatic lesions and their borders. However, small pancreatic lesions are not clearly identified or are unidentified even using all modalities (13% of our series).…”