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

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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.

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Acknowledgments

The authors are grateful to Rosalind Roberts for linguistic revision. A.S. designed the study, contributed to data acquisition and drafted the manuscript. A.Z. and G.T. substantially contributed to study conception, interpretation of data, critical revision of the manuscript. A.M., L.L., M.M. substantially contributed to study conception and data interpretation, and critically revised the manuscript for important intellectual content. D.D.F., M.S., F.R.L. acquired the data and participated in drafting the article. All authors gave their approval of the final version.

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Authors and Affiliations

  1. Unità Operativa e Cattedra di Chirurgia Generale, Università degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy

    Antonino Spinelli, Daniele Del Fabbro, Matteo Sacchi, Alessandro Zerbi, Guido Torzilli & Marco Montorsi

  2. Unità Operativa di Radiologia, Dipartimento di Diagnostica per Immagini, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy

    Fabio R. Lutman

  3. Unità Operativa di Gastroenterologia, Università degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy

    Luigi Laghi & Alberto Malesci

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  1. Antonino Spinelli
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  2. Daniele Del Fabbro
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  3. Matteo Sacchi
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  4. Alessandro Zerbi
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  9. Marco Montorsi
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Correspondence to Antonino Spinelli.

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Spinelli, A., Del Fabbro, D., Sacchi, M. et al. Intraoperative Ultrasound with Contrast Medium in Resective Pancreatic Surgery: A Pilot Study. World J Surg 35, 2521–2527 (2011). https://doi.org/10.1007/s00268-011-1199-z

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  • DOI: https://doi.org/10.1007/s00268-011-1199-z

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