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Intraoperative Ultrasound with Contrast Medium in Resective Pancreatic Surgery: A Pilot Study

Spinelli, Antonino ; Del Fabbro, Daniele ; Sacchi, Matteo ; Zerbi, Alessandro ; Torzilli, Guido ; Lutman, Fabio ; Laghi, Luigi ; Malesci, Alberto ; Montorsi, Marco

World Journal of Surgery, 2011, Vol.35(11), pp.2521-2527 [Rivista Peer Reviewed]

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  • Titolo:
    Intraoperative Ultrasound with Contrast Medium in Resective Pancreatic Surgery: A Pilot Study
  • Autore: Spinelli, Antonino ; Del Fabbro, Daniele ; Sacchi, Matteo ; Zerbi, Alessandro ; Torzilli, Guido ; Lutman, Fabio ; Laghi, Luigi ; Malesci, Alberto ; Montorsi, Marco
  • Note di contenuto: Byline: Antonino Spinelli (1), Daniele Del Fabbro (1), Matteo Sacchi (1), Alessandro Zerbi (1), Guido Torzilli (1), Fabio R. Lutman (2), Luigi Laghi (3), Alberto Malesci (3), Marco Montorsi (1) Abstract: Background The introduction of contrast-enhanced ultrasound has been a major innovation in liver and pancreatic imaging. Previous studies have validated its intraoperative use during liver surgery, while there is a lack of data regarding its use during pancreatic surgery. The purpose of the present study was to prospectively evaluate the possible role of contrast-enhanced intraoperative ultrasound (CEIOUS) during resective pancreatic surgery for primary lesion characterization and intraoperative staging. Materials and Methods Thirty-four patients (70% males, mean age 67.9 years) were selected for pancreatic surgery between October 2006 and July 2009. All patients underwent intraoperative ultrasound with intravenous injection of 4.8 mL sulfur-hexafluoride microbubbles. Location of the primary tumor, relation to the main vessels, contrast medium uptake modalities, presence of liver metastases, and multifocal pancreatic involvement were evaluated. The majority of operations were pancreatoduodenectomies (70.6%) performed for pancreatic ductal adenocarcinoma (64.7%). Results Additional lesions were detected by ultrasound in six patients (17.6%: liver metastases in four patients, a hemangioma in one patient, and a further pancreatic lesion in one patient). In five of these patients (5/34, 14.7%) surgical management was modified by these findings. All these new findings were diagnosed before injection of contrast medium, except for a metastasis from a neuroendocrine tumor the characterization of the hemangioma was possible only after contrast injection. Intraoperative findings regarding location of primary tumor, relation to the main vessels, and lesion characterization did not differ from those obtained with preoperative imaging. Conclusions In our experience intraoperative ultrasound is a valid technique for intraoperative staging prior to pancreatic resection it is unclear whether, in pancreatic surgery, the addition of contrast enhancement adds any benefit to traditional intraoperative ultrasound. Author Affiliation: (1) Unita Operativa e Cattedra di Chirurgia Generale, Universita degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy (2) Unita Operativa di Radiologia, Dipartimento di Diagnostica per Immagini, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy (3) Unita Operativa di Gastroenterologia, Universita degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy Article History: Registration Date: 31/07/2011 Online Date: 01/09/2011 Article note: This study was presented as a poster at the Second Pancreas Cancer Congress 2008 (6--8 April, Rome, Italy) and as an oral presentation at the 18th IASGO World Congress 2008 (8--11th October, Istanbul).
  • Fa parte di: World Journal of Surgery, 2011, Vol.35(11), pp.2521-2527
  • Soggetti: Cancer Metastasis ; Liver Cancer ; Cancer Research ; Surgery
  • Lingua: Inglese
  • Tipo: Articolo
  • Identificativo: ISSN: 0364-2313 ; E-ISSN: 1432-2323 ; DOI: 10.1007/s00268-011-1199-z

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