Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery - Analysis of impact and input.

Autor: Werner JM; Department of Surgery, University Hospital Regensburg, Regensburg, Germany., Zidek M; Department of Surgery, University Hospital Regensburg, Regensburg, Germany., Kammerer S; Department of Radiology, University Hospital Regensburg, Regensburg, Germany., da Silva NPB; Department of Radiology, University Hospital Regensburg, Regensburg, Germany., Jung F; Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany., Schlitt HJ; Department of Surgery, University Hospital Regensburg, Regensburg, Germany., Hornung M; Department of Surgery, University Hospital Regensburg, Regensburg, Germany., Jung EM; Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Jazyk: angličtina
Zdroj: Clinical hemorheology and microcirculation [Clin Hemorheol Microcirc] 2021; Vol. 78 (1), pp. 103-116.
DOI: 10.3233/CH-201031
Abstrakt: Objective: To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the outcome after hepato-pancreatico-biliary (HPB) surgery.
Materials and Methods: Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4-5 ml dulphur hexafluoride microbubbles using a 6-9 MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer.
Results: The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%).The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required.Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand.
Conclusion: Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases.
Databáze: MEDLINE
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