Contrast-enhanced intraoperative ultrasound (CE-IOUS) in patients with pancreatic cancer undergoing surgery: an initial experience

Abstract

Purpose: The implementation of contrast-enhanced ultrasound represents an important innovation in hepato-pancreato-biliary imaging. Previous studies have validated contrast-enhanced intraoperative ultrasound (CE-IOUS) during liver surgery. Nonetheless, there is limited evidence regarding its use during pancreatic surgery. The purpose of the present study was to prospectively assess the potential role of CE-IOUS during pancreatic surgery for the evaluation of resectability/staging of the primary tumor, along with identification of potential liver metastases. Method: The protocol of the present study has been registered at clinicaltrials.gov (identifier: NCT04683497). Ten patients (60% males, mean age 61 years) underwent surgery for pancreatic cancer between November 2020 and January 2021. All patients underwent multidetector Computed Tomography (MDCT), Magnetic Resonance Imaging (MRI), IOUS and CE-IOUS using Sonovue©. Location of the primary tumor, relation to the main vessels, contrast medium uptake modalities, presence of liver metastases, and multifocal pancreatic involvement were evaluated. Results: Nine of the included patients presented pancreatic ductal adenocarcinoma and one patient presented acinar cell carcinoma (head:7, tail:3). Three new liver lesions (all metastases) were identified using CE-IOUS in two patients (20%) leading to a change of surgical plan (Whipple procedure with resection of segment IV in one patient and Whipple procedure with wedge resection in the second patient). All these new findings were diagnosed after contrast-enhancement; one injection was performed per lesion. Intraoperative findings regarding the location and characteristics of primary tumor did not differ from those obtained with preoperative imaging. Conclusions: According to our initial experience, CE-IOUS is a safe and efficient imaging modality with a direct impact on operation strategy.