Abstracts
1998 Digestive Disease Week

#1021

INTRAOPERATIVE ULTRASOUND IMPROVES DIAGNOSTIC AND THERAPEUTIC STRATEGIES DURING PANCREATIC SURGERY. R.J. Hendrickson, C.M. Schmidt, C.R. Cappadona, L.T. Tio* and J.V. Sitzmann. Departments of Surgery and *Medicine, Georgetown University Medical Center. Washington, DC.

Pre-operative work-up of pancreatic masses continues to evolve in order to improve staging accuracy. Limitations in pre-operative staging continues to affect operative management. Thus, operative information remains the critical component of most pancreatic procedures. We, therefore, sought to determine if routine intraoperative ultrasound (IOUS) could enhance the intraoperative surgical decision process. From 8/95-11/97 a single surgeon (JVS) conducted 70 consecutive IOUS on patients with a preoperative diagnosis of pancreatic mass. For each operation: 1.) preoperative impression, 2.) intraoperative impression before & after IOUS, and 3.) the effect of IOUS on diagnosis and treatment (assisted greatly, mildly or no assistance) were recorded. IOUS assisted mildly or greatly in staging 59/70 (84%) patients at the time of operation. Thirty-seven patients were assisted greatly and 22 were assisted mildly by IOUS. Preoperative impression of 22 patients was classified as "cancer vs. benign disease". All 22 benefitted from IOUS (7 mildly and 15 greatly). Twenty patients were classified as "cancer: resectable" and 13 benefitted from IOUS (5 mildly and 8 greatly). Twenty-eight patients were classified as "cancer: question of resectability" and 24 benefitted from IOUS (10 mildly and 14 greatly). Intraoperative impression changed in 51/70 (73%) patients after IOUS. This was most important in patients with "cancer vs. benign disease" in which the impression was changed in 16 of 17 (94%) patients, and patients with "cancer: question of resectability" in which the impression changed in 24 of 24 (100%) patients. This study illustrates that IOUS plays a significant role in staging patients during pancreatic surgery. IOUS aids in determining resectability, identifying accessory ducts or pancreatic ducts, vessel involvement, metastatic disease or aberrant anatomy. We conclude that routine IOUS should be employed for most, if not all, intraoperative pancreatic surgical evaluations.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.