The use of operative sonography in carcinoma of the pancreas

We studied 22 patients who underwent surgery for suspected pancreatic carcinoma. One individual was found to have a normal pancreas and one mass was finally diagnosed as chronic pancreatitis. Accurate diagnoses were made preoperatively in 63% of our patients. All masses were palpated intraoperativel...

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Bibliographic Details
Published in:World journal of surgery 1987-10, Vol.11 (5), p.654-658
Main Authors: Plainfosse, M. C., Bouillot, J. L., Rivaton, F., Vaucamps, P., Hernigou, A., Alexandre, J. H.
Format: Article
Language:English
Subjects:
Accurate Diagnosis
Aged
Biological and medical sciences
Carcinoma
Carcinoma - diagnosis
Carcinoma - surgery
Chronic Pancreatitis
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Intraoperative Care
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Palpation
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - surgery
Pancreatitis
Preoperative Care
Public Health
Tomography, X-Ray Computed
Tumors
Ultrasonography
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Summary:We studied 22 patients who underwent surgery for suspected pancreatic carcinoma. One individual was found to have a normal pancreas and one mass was finally diagnosed as chronic pancreatitis. Accurate diagnoses were made preoperatively in 63% of our patients. All masses were palpated intraoperatively. Operative ultrasonography confirmed these findings and the absence of a mass in the patient with a normal pancreas. Operative sonography (OS) revealed 2 previously undetected lesions and permitted 2 biopsies of lesions under its guidance. It was helpful in diagnosing 18% of lesions. In evaluating the spread of pancreatic carcinoma, OS was very helpful in 32% of our patients and moderately helpful in 18%. OS thus helped to direct surgical management in 50% of our patients, by providing information that limited dissection in patients with unresectable spread or permitted resection to proceed in the absence of evidence of unresectability. Résumé A partir d'une expérience concernant 22 malades, les auteurs pensent que l'échographie per‐opératoire peut améliorer le diagnostic et le traitement du cancer du pancréas. La comparaison entre les données de l'imagerie pré‐opératoire et celle de l'exploration chirurgicale combinée à l'échographie per‐opératoire mit en évidence un cas de faux positif chez un malade porteur d'une cirrhose et d'une volumineuse tête du pancréas ainsi que 7 cas de faux négatifs chez lesquels une tumeur ne fut pas découverte. Chez ces 7 malades, la palpation opératoire fut suffisante pour découvrir la tumeur. L'échographie opératoire permet également d'apprécier l'extension du processus tumoral aux axes vasculaires et au foie, ces faits s'opposant à l'indication de l'exérèse. Chez 9 des 22 patients l'inspection et la palpation chirurgicales décelèrent l'extension du cancer au péritoine, aux lymphatiques, à la racine du mésentère. Dans 50% l'échographie per‐opératoire améliora l'appréciation exacte de l'extension. Resumen La sonografía operatoria (SO) puede mejorar el diagnóstico y el tratamiento quirúrgico del carcinoma pancreático. Nuestra experiencia se eleva a 22 pacientes. La comparacíon entre la imagenología diagnóstica preoperatoria y la exploración por el cirujano asistida por SO demostró un resultado falso positivo en un paciente con cirrosis biliar primaria y una cabeza pancreática grande y 7 falsos negativos en los cuales la masa no fue detectada; en estos 7 pacientes la palpación por el cirujano fue suficiente para hallar el carcinom
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01655843